Provider Demographics
NPI:1265985105
Name:EVANS, TAYLOR LEIGH (OTR/L)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LEIGH
Last Name:EVANS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6300
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:CO
Mailing Address - Zip Code:80435-6300
Mailing Address - Country:US
Mailing Address - Phone:304-237-6167
Mailing Address - Fax:
Practice Address - Street 1:240 E LA BONTE ST UNIT 54
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:CO
Practice Address - Zip Code:80435-5885
Practice Address - Country:US
Practice Address - Phone:304-237-6167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0006776225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics