Provider Demographics
NPI:1003696915
Name:GUDA, TAYLOR LYNN
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LYNN
Last Name:GUDA
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 1:31 ETRURIA ST APT C
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-1685
Mailing Address - Country:US
Mailing Address - Phone:724-205-8757
Mailing Address - Fax:
Practice Address - Street 1:4640 S 144TH ST
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-4134
Practice Address - Country:US
Practice Address - Phone:206-901-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC61409073224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant