Provider Demographics
NPI:1639816739
Name:KOUTS, TAYLOR JENSEN (OTR/L, OTD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JENSEN
Last Name:KOUTS
Suffix:
Gender:F
Credentials:OTR/L, OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13613 AVENUE W
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1281
Mailing Address - Country:US
Mailing Address - Phone:214-448-8543
Mailing Address - Fax:
Practice Address - Street 1:6104 66TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-5934
Practice Address - Country:US
Practice Address - Phone:107-180-6317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist