Healthcare Provider Details

I. General information

NPI: 1306323548
Provider Name (Legal Business Name): TAYLOR PARKS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 N SOUTHPORT AVE APT 2R
CHICAGO IL
60657-4249
US

IV. Provider business mailing address

3040 N SOUTHPORT AVE APT 2R
CHICAGO IL
60657-4249
US

V. Phone/Fax

Practice location:
  • Phone: 502-542-9242
  • Fax:
Mailing address:
  • Phone: 502-542-9242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number17-35802
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: