Provider Demographics
NPI:1578639902
Name:TAYLOR, MARCI RAY (OTR, BCABA)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:RAY
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:OTR, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15302 ANTLER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-2011
Mailing Address - Country:US
Mailing Address - Phone:210-479-8541
Mailing Address - Fax:210-340-6437
Practice Address - Street 1:85 NE LOOP 410
Practice Address - Street 2:SUITE 209
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5829
Practice Address - Country:US
Practice Address - Phone:210-340-2627
Practice Address - Fax:210-340-6437
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0-02-05202080P0006X
TX106160225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T0563OtherBLUE CROSS ID