Healthcare Provider Details

I. General information

NPI: 1053881565
Provider Name (Legal Business Name): ELENA JOY TAYLOR OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2076 S 2ND ST
MILAN TN
38358-3023
US

IV. Provider business mailing address

2076 S 2ND ST
MILAN TN
38358-3023
US

V. Phone/Fax

Practice location:
  • Phone: 325-280-3699
  • Fax: 855-232-8604
Mailing address:
  • Phone: 325-280-3699
  • Fax: 855-232-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6088
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: