Healthcare Provider Details

I. General information

NPI: 1417596073
Provider Name (Legal Business Name): TAYLOR SWAIN SIMPSON OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2019
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W 8TH ST
JACKSONVILLE FL
32209-6511
US

IV. Provider business mailing address

1050 INDUSTRIAL RD STE 210
MIDDLETOWN DE
19709-2803
US

V. Phone/Fax

Practice location:
  • Phone: 904-244-1157
  • Fax:
Mailing address:
  • Phone: 302-389-7855
  • Fax: 302-449-2047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberU1-0002117
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: