Provider Demographics
NPI:1942413505
Name:TAYLOR, LISA ANN (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6829 AMBERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-9801
Mailing Address - Country:US
Mailing Address - Phone:865-281-2571
Mailing Address - Fax:
Practice Address - Street 1:3305 W END AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1035
Practice Address - Country:US
Practice Address - Phone:615-386-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT0000001815225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist