Provider Demographics
NPI:1689090318
Name:MASON, TAYLOR (MS)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-2722
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:497 MAIN ST
Practice Address - Street 2:SUITE E
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-1298
Practice Address - Country:US
Practice Address - Phone:978-448-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10714225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist