Provider Demographics
NPI:1750766259
Name:AZUA, TAYLOR ASHLEY (OT)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ASHLEY
Last Name:AZUA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:ASHLEY
Other - Last Name:IVIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3526 KINGS CIR
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-1208
Mailing Address - Country:US
Mailing Address - Phone:512-789-2806
Mailing Address - Fax:
Practice Address - Street 1:1200 S HALL ST
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-6339
Practice Address - Country:US
Practice Address - Phone:512-789-2806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-25
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113356225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist