Provider Demographics
NPI:1568685170
Name:TAYLOR, BRIAN (OT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W CRYSTAL LAKE AVE
Mailing Address - Street 2:APT. 111D
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-3100
Mailing Address - Country:US
Mailing Address - Phone:609-670-6568
Mailing Address - Fax:
Practice Address - Street 1:2305 RANCOCAS RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-4113
Practice Address - Country:US
Practice Address - Phone:609-747-8619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00388200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist