Provider Demographics
NPI:1750598181
Name:TAYLOR, CORY LYNN (OTRL)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:LYNN
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1947 WOPSY RD
Mailing Address - Street 2:
Mailing Address - City:DYSART
Mailing Address - State:PA
Mailing Address - Zip Code:16636-9005
Mailing Address - Country:US
Mailing Address - Phone:814-931-7370
Mailing Address - Fax:
Practice Address - Street 1:1155 INDIAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3466
Practice Address - Country:US
Practice Address - Phone:724-464-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009062225X00000X
MD05548225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist