Provider Demographics
NPI:1669294476
Name:TAYLOR, VIOLA I (COTA/L 786)
Entity type:Individual
Prefix:MS
First Name:VIOLA
Middle Name:I
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:COTA/L 786
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BASIN
Mailing Address - State:WY
Mailing Address - Zip Code:82410-9545
Mailing Address - Country:US
Mailing Address - Phone:307-462-1998
Mailing Address - Fax:
Practice Address - Street 1:120 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401-3637
Practice Address - Country:US
Practice Address - Phone:307-347-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY786224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant