Individual
GWEN RENE TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
803 HUFFMAN ST, FORT WAYNE, IN 46808-3245
(260) 424-3540
Mailing address
803 HUFFMAN ST, FORT WAYNE, IN 46808-3245
(260) 424-3540
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32002140A
IN
Other
Enumeration date
06/11/2012
Last updated
06/11/2012
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