Provider Demographics
NPI:1417147109
Name:TAYLOR, GRETCHEN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:GRETCHEN
Other - Middle Name:
Other - Last Name:GAITAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:8650 SW 109TH AVE
Mailing Address - Street 2:209
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4468
Mailing Address - Country:US
Mailing Address - Phone:305-710-8737
Mailing Address - Fax:305-279-3364
Practice Address - Street 1:8650 SW 109TH AVE
Practice Address - Street 2:209
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-4468
Practice Address - Country:US
Practice Address - Phone:305-710-8737
Practice Address - Fax:305-279-3364
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-28
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 10802225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8899584 00Medicaid