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General NPI Number Information
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NPI Number | 1215213392
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Entity Type | Individual
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Provider Name | TANJA LYNETTE TAYLOR OT, CHT
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Gender | Female
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Dates
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Enumeration Date | 11/02/2011
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 3400 MCCLURE BRIDGE RD STE F601
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City | DULUTH
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State | GA
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Zip | 30096-8740
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Country | US
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Telephone | 678-682-8828
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Fax | 678-682-8830
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Provider Business Mailing Address
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Address Line | 2400 WISTERIA DR STE A
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City | SNELLVILLE
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State | GA
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Zip | 30078-2689
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Country | US
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Telephone | 770-982-0102
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Fax | 770-982-0130
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 000633
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License Number State | GA
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