Healthcare Provider Details

I. General information

NPI: 1467460378
Provider Name (Legal Business Name): HEATHER RUTH TAYLOR OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER TAYLOR PURCELL OTR

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 REGIONAL DR. SUITE #7
CONCORD NH
03301
US

IV. Provider business mailing address

57 REGIONAL DR. SUITE #7
CONCORD NH
03301
US

V. Phone/Fax

Practice location:
  • Phone: 603-226-2900
  • Fax: 603-226-2903
Mailing address:
  • Phone: 603-226-2900
  • Fax: 603-226-2903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2263
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: