MEDICARE: TAYLOR CIMBALIST HEFTI MOT, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	2542	ID
2	225X00000X	Occupational Therapist	17834	NC

General Provider Information

NPI Number	:	1366182537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR CIMBALIST HEFTI MOT, OTR/L

Provider Business Mailing Address
First Line	:	525 E PARKCENTER BLVD APT 102
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83706-6753
Country	:	US
Telephone Number	:	757-752-1071
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 GROVE ST N
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-2342
Country	:	US
Telephone Number	:	757-752-1071
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2022
Last Update Date	:	03/10/2026

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