Provider Demographics
NPI:1467714667
Name:TAYLOR, TAHERA SHARONDA (OT)
Entity Type:Individual
Prefix:MISS
First Name:TAHERA
Middle Name:SHARONDA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8419
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39535-8087
Mailing Address - Country:US
Mailing Address - Phone:228-388-5714
Mailing Address - Fax:228-388-0017
Practice Address - Street 1:2541 PASS RD
Practice Address - Street 2:F
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2106
Practice Address - Country:US
Practice Address - Phone:228-388-1002
Practice Address - Fax:228-388-1006
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT2650225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist