Provider Demographics
NPI:1922760818
Name:PONTI, TAYLOR (OTR/L)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:PONTI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3632 BEVERLY COVE WAY APT 208
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-0850
Mailing Address - Country:US
Mailing Address - Phone:609-649-9857
Mailing Address - Fax:
Practice Address - Street 1:3800 INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2599
Practice Address - Country:US
Practice Address - Phone:910-392-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist