Healthcare Provider Details

I. General information

NPI: 1083223325
Provider Name (Legal Business Name): TAYLOR BETH CONAWAY OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR BETH DELP OTD, OTR/L

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S 3RD ST
ENID OK
73701-5737
US

IV. Provider business mailing address

1735 NW 37TH ST
OKLAHOMA CITY OK
73118-2806
US

V. Phone/Fax

Practice location:
  • Phone: 580-249-4260
  • Fax:
Mailing address:
  • Phone: 402-658-6824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number2156
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: