Provider Demographics
NPI:1366043168
Name:TAYLOR WOLF, SIERRA ALEXIS (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:ALEXIS
Last Name:TAYLOR WOLF
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 S DANYELL PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-1162
Mailing Address - Country:US
Mailing Address - Phone:850-374-1731
Mailing Address - Fax:
Practice Address - Street 1:20439 SCIOTO TER
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-7009
Practice Address - Country:US
Practice Address - Phone:850-374-1731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119008681225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist