Healthcare Provider Details

I. General information

NPI: 1023072881
Provider Name (Legal Business Name): SHANNON LEIGH TAYLOR OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 08/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 I-630 EXIT 7
LITTLE ROCK AR
72205-7202
US

IV. Provider business mailing address

9601 I-630 EXIT 7
LITTLE ROCK AR
72205-7202
US

V. Phone/Fax

Practice location:
  • Phone: 501-202-7598
  • Fax:
Mailing address:
  • Phone: 501-202-7598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR1308
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOTR1308
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: