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NPI Code Detail

MEDICARE: MRS. CANDRA SELENE TAYLOR OTR

MEDICARE: MRS. CANDRA SELENE TAYLOR OTR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist2613AL

General Provider Information

NPI Number : 1588874507
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CANDRA SELENE TAYLOR OTR
Provider Business Mailing Address
First Line : 5955 MOCKINGBIRD LN
Second Line :
City : PINSON
State : AL
Zip : 35126-3458
Country : US
Telephone Number : 205-680-2032
Fax Number :
Provider Business Practice Location Address
First Line : 3605 RATLIFF RD
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35210-4512
Country : US
Telephone Number : 205-956-2184
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2007
Last Update Date : 07/08/2007

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