Provider Demographics
NPI:1336494582
Name:TAGLORIN, KRYSTAL FAITH DORILLO (MS OCCUPATIONAL TH)
Entity Type:Individual
Prefix:MS
First Name:KRYSTAL FAITH
Middle Name:DORILLO
Last Name:TAGLORIN
Suffix:
Gender:F
Credentials:MS OCCUPATIONAL TH
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Mailing Address - Street 1:4560 SE INTERNATIONAL WAY
Mailing Address - Street 2:STE. 100
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222
Mailing Address - Country:US
Mailing Address - Phone:971-206-5200
Mailing Address - Fax:971-206-5203
Practice Address - Street 1:4367 CONCORD BLVD.
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521
Practice Address - Country:US
Practice Address - Phone:925-689-7457
Practice Address - Fax:925-680-2789
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA12612225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist