Individual
CARLY TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
3410 MAGNOLIA ST, TEXARKANA, TX 75503-3729
(903) 792-3003
(903) 794-1005
Mailing address
4304 IDALOU DR, TEXARKANA, TX 75503-0531
(903) 276-1885
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
211057
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
211057
TEXAS BOARD OF THERAPY EXAMINERS
TX
Enumeration date
09/20/2011
Last updated
09/20/2011
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