Provider Demographics
NPI:1952840902
Name:CHESHIRE, TAYLOR RENEE
Entity Type:Individual
Prefix:MISS
First Name:TAYLOR
Middle Name:RENEE
Last Name:CHESHIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 SPRINGLAKE DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-5072
Mailing Address - Country:US
Mailing Address - Phone:229-894-0971
Mailing Address - Fax:
Practice Address - Street 1:198 SPRINGLAKE DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-5072
Practice Address - Country:US
Practice Address - Phone:229-894-0971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA002202224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant