Provider Demographics
NPI:1679229546
Name:BLENDEN, TAYLOR (OTR)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:BLENDEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 TRAILMORE DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-2707
Mailing Address - Country:US
Mailing Address - Phone:757-572-1003
Mailing Address - Fax:
Practice Address - Street 1:2323 CUMBERLAND PKWY SE STE 104
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-4523
Practice Address - Country:US
Practice Address - Phone:770-927-7424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist