Provider Demographics
NPI:1972690469
Name:TAYLOR, JULIA DAVIS (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:DAVIS
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:JULIA
Other - Middle Name:DAVIS
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:82322 BEAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CRESWELL
Mailing Address - State:OR
Mailing Address - Zip Code:97426-9837
Mailing Address - Country:US
Mailing Address - Phone:541-221-7458
Mailing Address - Fax:
Practice Address - Street 1:1 HAYDEN BRIDGE WAY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1347
Practice Address - Country:US
Practice Address - Phone:541-868-9430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2020-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1075573225X00000X
FL19004225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890643200Medicaid