Provider Demographics
NPI:1154481414
Name:TAYLOR, KERRY (OTR-L)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
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 1:29755 N VARNUM RD
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-7007
Mailing Address - Country:US
Mailing Address - Phone:480-239-5741
Mailing Address - Fax:480-635-0222
Practice Address - Street 1:29755 N VARNUM RD
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-7007
Practice Address - Country:US
Practice Address - Phone:480-239-5741
Practice Address - Fax:480-635-0222
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2670225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ539380Medicaid