Healthcare Provider Details

I. General information

NPI: 1639373145
Provider Name (Legal Business Name): JENNIFER DIONNE TAYLOR OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER DIONNE MORTON OTR

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 CROMWELL PARK DR
GLEN BURNIE MD
21061-2566
US

IV. Provider business mailing address

1117 WYNBROOK RD
GLEN BURNIE MD
21060-7026
US

V. Phone/Fax

Practice location:
  • Phone: 410-590-4926
  • Fax:
Mailing address:
  • Phone: 443-306-4672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number05085
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number05085
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number05085
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number05085
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: