Healthcare Provider Details

I. General information

NPI: 1710891346
Provider Name (Legal Business Name): TAYLOR MATHEWS OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WAXHAW PROFESSIONAL PARK DR STE A
WAXHAW NC
28173-5018
US

IV. Provider business mailing address

1440 HARDING PL APT 563
CHARLOTTE NC
28204-0045
US

V. Phone/Fax

Practice location:
  • Phone: 704-627-4027
  • Fax: 704-684-4644
Mailing address:
  • Phone: 832-579-7672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number18730
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: