Healthcare Provider Details

I. General information

NPI: 1356023147
Provider Name (Legal Business Name): TAYLOR GERACE OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S STATE RD
SPRINGFIELD PA
19064-1243
US

IV. Provider business mailing address

721 CREGHAN AVE
SWARTHMORE PA
19081-2905
US

V. Phone/Fax

Practice location:
  • Phone: 610-356-1991
  • Fax:
Mailing address:
  • Phone: 610-348-3984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: