Provider Demographics
NPI:1184379877
Name:BROOKS, TAYLOR (OTR/L)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:FALIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:8090 SKYSTONE LOOP
Mailing Address - Street 2:
Mailing Address - City:MANASSAS PARK
Mailing Address - State:VA
Mailing Address - Zip Code:20111-7241
Mailing Address - Country:US
Mailing Address - Phone:302-983-2537
Mailing Address - Fax:
Practice Address - Street 1:12751 SUDLEY MANOR DR
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-2726
Practice Address - Country:US
Practice Address - Phone:571-781-5414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119-007612225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist