Provider Demographics
NPI:1184939852
Name:ROY, TAI ANN
Entity type:Individual
Prefix:MRS
First Name:TAI
Middle Name:ANN
Last Name:ROY
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 1:13314 E 700TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:IL
Mailing Address - Zip Code:62454-6368
Mailing Address - Country:US
Mailing Address - Phone:618-544-4620
Mailing Address - Fax:
Practice Address - Street 1:13314 E 700TH AVE
Practice Address - Street 2:
Practice Address - City:ROBINSON
Practice Address - State:IL
Practice Address - Zip Code:62454-6368
Practice Address - Country:US
Practice Address - Phone:618-544-4620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist