Provider Demographics
NPI:1477270783
Name:PEREZ, TAYLER B (OTR)
Entity Type:Individual
Prefix:
First Name:TAYLER
Middle Name:B
Last Name:PEREZ
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 1:8904 STONE PARK DR APT 2022
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-1646
Mailing Address - Country:US
Mailing Address - Phone:325-451-4655
Mailing Address - Fax:
Practice Address - Street 1:1652 KELLER PKWY STE 100
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3876
Practice Address - Country:US
Practice Address - Phone:817-562-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123100225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics