Provider Demographics
NPI:1457486987
Name:TAYLOR, HEATHER RENEA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:RENEA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WEBBLY LN
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714-2909
Mailing Address - Country:US
Mailing Address - Phone:479-855-2613
Mailing Address - Fax:
Practice Address - Street 1:1004 BEAU TERRE DR
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-6738
Practice Address - Country:US
Practice Address - Phone:479-903-1018
Practice Address - Fax:855-738-7702
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001000598225XP0200X
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
MO475287876Medicaid