Provider Demographics
NPI:1467876334
Name:TAYLOR, SHELLIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHELLIE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-2104
Mailing Address - Country:US
Mailing Address - Phone:315-207-2222
Mailing Address - Fax:315-343-6923
Practice Address - Street 1:127 E 1ST ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2104
Practice Address - Country:US
Practice Address - Phone:315-207-2222
Practice Address - Fax:315-343-6923
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009539-1225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist