Healthcare Provider Details

I. General information

NPI: 1023456779
Provider Name (Legal Business Name): TAYLOR CANSLER WOMACK OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 BROADRICK DR
DALTON GA
30720-2504
US

IV. Provider business mailing address

1225 BROADRICK DR
DALTON GA
30720-2504
US

V. Phone/Fax

Practice location:
  • Phone: 706-272-6199
  • Fax:
Mailing address:
  • Phone: 706-272-6199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number005160
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: