Provider Demographics
NPI:1922743780
Name:IITTLE, TAYLA
Entity type:Individual
Prefix:
First Name:TAYLA
Middle Name:
Last Name:IITTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BIGWOOD LOOP UNIT 105
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-3531
Mailing Address - Country:US
Mailing Address - Phone:419-796-2099
Mailing Address - Fax:
Practice Address - Street 1:12 BIGWOOD LOOP UNIT 105
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-3531
Practice Address - Country:US
Practice Address - Phone:419-796-2099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
OH385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)