Provider Demographics
NPI:1609232610
Name:BILLINGSLEY, TAYLOR (OTA)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:BILLINGSLEY
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 KNIGHT ST
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335-3348
Mailing Address - Country:US
Mailing Address - Phone:870-261-3328
Mailing Address - Fax:
Practice Address - Street 1:217 N 5TH ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-3212
Practice Address - Country:US
Practice Address - Phone:870-732-2844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT2015-041224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant