Healthcare Provider Details

I. General information

NPI: 1508788563
Provider Name (Legal Business Name): MATTHEW DEAN TAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12130 PENNSYLVANIA ST
THORNTON CO
80241-3132
US

IV. Provider business mailing address

6705 W 56TH AVE APT 301
ARVADA CO
80002-3214
US

V. Phone/Fax

Practice location:
  • Phone: 720-806-5019
  • Fax:
Mailing address:
  • Phone: 913-225-4420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT.0009429
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: