Provider Demographics
NPI:1831962539
Name:KEENE, TAYLOR LORAN (COTA)
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:LORAN
Last Name:KEENE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3941 GREENWICH MILAN TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:OH
Mailing Address - Zip Code:44837-9437
Mailing Address - Country:US
Mailing Address - Phone:419-951-3176
Mailing Address - Fax:
Practice Address - Street 1:410 FAIR LN
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2518
Practice Address - Country:US
Practice Address - Phone:419-443-0059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH497750224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant