Provider Demographics
NPI:1114293792
Name:TAYLOR, SHELLY RAE (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:RAE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10441 STATE ROUTE 125
Mailing Address - Street 2:
Mailing Address - City:W PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45663-8911
Mailing Address - Country:US
Mailing Address - Phone:740-877-5718
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:10441 STATE ROUTE 125
Practice Address - Street 2:
Practice Address - City:W PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45663-8911
Practice Address - Country:US
Practice Address - Phone:740-877-5718
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT006789225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology