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NPI Code Detail

MEDICARE: TIFFINEY TAYLOR OTR/L

MEDICARE:   TIFFINEY  TAYLOR  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
1225X00000XOccupational Therapist056.008789IL

General Provider Information

NPI Number : 1508190729
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFINEY TAYLOR OTR/L
Provider Business Mailing Address
First Line : 5065 W MONROE ST
Second Line : 1ST FLOOR
City : CHICAGO
State : IL
Zip : 60644-4136
Country : US
Telephone Number : 773-653-6065
Fax Number :
Provider Business Practice Location Address
First Line : 5065 W MONROE ST
Second Line : 1ST FLOOR
City : CHICAGO
State : IL
Zip : 60644-4136
Country : US
Telephone Number : 773-653-6065
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2009
Last Update Date : 09/21/2009

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Directions to “ TIFFINEY TAYLOR OTR/L” Practice Location

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