Provider Demographics
NPI:1215213392
Name:TAYLOR, TANJA LYNETTE (OT, CHT)
Entity Type:Individual
Prefix:MRS
First Name:TANJA
Middle Name:LYNETTE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:OT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 WISTERIA DR STE A
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2689
Mailing Address - Country:US
Mailing Address - Phone:770-982-0102
Mailing Address - Fax:770-982-0130
Practice Address - Street 1:3400 MCCLURE BRIDGE RD STE F601
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8740
Practice Address - Country:US
Practice Address - Phone:678-682-8828
Practice Address - Fax:678-682-8830
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000633225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist