Provider Demographics
NPI:1366188633
Name:PANDORF, TAYLOR (COTA/L)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:PANDORF
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 LINCOLN PARK E
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-3125
Mailing Address - Country:US
Mailing Address - Phone:908-276-7100
Mailing Address - Fax:
Practice Address - Street 1:600 LINCOLN PARK E
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-3125
Practice Address - Country:US
Practice Address - Phone:908-276-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09178100224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJAHY-1042386101OtherMERCER