Provider Demographics
NPI:1659821569
Name:TAYLOR, TAYLOR GRACE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:GRACE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 ROO PL
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-5106
Mailing Address - Country:US
Mailing Address - Phone:276-395-0473
Mailing Address - Fax:
Practice Address - Street 1:236 ROO PL
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-5106
Practice Address - Country:US
Practice Address - Phone:276-395-0473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001337224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU46106502 02OtherCIGNA