Provider Demographics
NPI:1366568669
Name:TAYLOR, ANN MARIE (OTA)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 MILNE DR
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-3816
Mailing Address - Country:US
Mailing Address - Phone:815-462-4928
Mailing Address - Fax:815-462-4929
Practice Address - Street 1:14409 EDISON DR
Practice Address - Street 2:UNIT 1
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-3670
Practice Address - Country:US
Practice Address - Phone:815-462-4928
Practice Address - Fax:815-462-4929
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant