Individual
MRS. TAYLOR GRACE TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
236 ROO PL, BRISTOL, VA 24201-5106
(276) 395-0473
Mailing address
236 ROO PL, BRISTOL, VA 24201-5106
(276) 395-0473
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131001337
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
U46106502 02
CIGNA
VA
Enumeration date
10/04/2016
Last updated
10/04/2016
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