Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 3970-26 | WI |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 7843 | CA |
NPI | 1326434945 |
---|---|
Provider Name | Mr. Larry James Taylor II |
First Address | Montebello, CA 90640-3775 |
Second Address | Montebello, CA 90640-3775 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2015 |
Last Update Date | 26/02/2016 |