Individual
TAYLOR LEIGH RIDDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3600 W 7TH ST, FORT WORTH, TX 76107-2534
(817) 377-3422
Mailing address
3600 W 7TH ST, FORT WORTH, TX 76107-2534
(817) 377-3422
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
210895
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
456678
MEDICARE
TX
Enumeration date
01/19/2012
Last updated
01/19/2012
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