Provider Demographics
NPI:1598934945
Name:MCCRARY-TAYLOR, EYVONNIA
Entity Type:Individual
Prefix:
First Name:EYVONNIA
Middle Name:
Last Name:MCCRARY-TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 GLENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-9263
Mailing Address - Country:US
Mailing Address - Phone:702-277-3402
Mailing Address - Fax:
Practice Address - Street 1:6150 GLENVIEW DR
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-9263
Practice Address - Country:US
Practice Address - Phone:801-942-3311
Practice Address - Fax:801-495-5303
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2019-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0390225X00000X
TX104260225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist