Provider Demographics
NPI:1255429924
Name:TAYLOR, LORI K (OT)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:K
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 1ST SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39669-3777
Mailing Address - Country:US
Mailing Address - Phone:601-888-7944
Mailing Address - Fax:607-888-4767
Practice Address - Street 1:558 1ST SOUTH ST
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:MS
Practice Address - Zip Code:39669-3777
Practice Address - Country:US
Practice Address - Phone:601-888-7944
Practice Address - Fax:607-888-4767
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOTO649174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00122865Medicaid
MSP71792Medicare UPIN
670000056Medicare ID - Type Unspecified
670000035Medicare PIN