Provider Demographics
NPI:1841024296
Name:TAYLOR, TERESA (COTA)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:TAYLOR
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 1:930 S LINCOLN ST APT 7
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-3856
Mailing Address - Country:US
Mailing Address - Phone:303-386-2266
Mailing Address - Fax:
Practice Address - Street 1:6270 N GOVERNMENT WAY
Practice Address - Street 2:
Practice Address - City:DALTON GARDENS
Practice Address - State:ID
Practice Address - Zip Code:83815-9214
Practice Address - Country:US
Practice Address - Phone:208-666-0611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant