Provider Demographics
NPI:1689746562
Name:TAYLOR, KATHY GUIRADO (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:GUIRADO
Last Name:TAYLOR
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:PO BOX 557
Mailing Address - Street 2:
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-0557
Mailing Address - Country:US
Mailing Address - Phone:229-423-8403
Mailing Address - Fax:229-423-8340
Practice Address - Street 1:112 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-2545
Practice Address - Country:US
Practice Address - Phone:229-423-8403
Practice Address - Fax:229-423-8340
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT000451225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist