Provider Demographics
NPI:1740841691
Name:TAYLOR, RONALD (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24076 SE STARK ST STE 210
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3376
Mailing Address - Country:US
Mailing Address - Phone:503-491-1667
Mailing Address - Fax:
Practice Address - Street 1:24076 SE STARK ST STE 210
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3376
Practice Address - Country:US
Practice Address - Phone:503-419-1666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR419597225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR419597OtherOCCUPATIONAL THERAPY LICENSE