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General NPI Number Information
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NPI Number | 1417621319
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Entity Type | Individual
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Provider Name | TAYLOR NICOLE LUSK OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/04/2021
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Last Update Date | 08/04/2021
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Provider Practice Location Address
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Address Line | 1436 CENTRAL AVE E
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City | WIGGINS
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State | MS
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Zip | 39577-9602
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Country | US
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Telephone | 601-928-1889
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Fax |
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Provider Business Mailing Address
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Address Line | 254 PARSONAGE DR
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City | DANIELS
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State | WV
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Zip | 25832-9687
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Country | US
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Telephone | 304-575-1594
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Fax |
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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 | OT-3859
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 2129
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License Number State | WV
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