Healthcare Provider Details

I. General information

NPI: 1871634873
Provider Name (Legal Business Name): TRISHA L. TAYLOR MOT, OTR L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 WINDING WOODS DR
O FALLON MO
63366-3976
US

IV. Provider business mailing address

139 WINDING WOODS DR
O FALLON MO
63366-3976
US

V. Phone/Fax

Practice location:
  • Phone: 314-406-5209
  • Fax:
Mailing address:
  • Phone: 314-406-5209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2004022422
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: