Provider Demographics
NPI:1730501719
Name:TAYLOR, ANDREA L (ATC, OTC, OT-SC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:ATC, OTC, OT-SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MEDICAL PARK RD STE 404
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6875
Mailing Address - Country:US
Mailing Address - Phone:803-434-8288
Mailing Address - Fax:803-434-5467
Practice Address - Street 1:2 MEDICAL PARK RD STE 404
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6875
Practice Address - Country:US
Practice Address - Phone:803-434-8288
Practice Address - Fax:803-434-5467
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer