Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OTR1308 | AR |
N | 225XH1200X | Occupational Therapist - Hand | OTR1308 | AR |
NPI | 1023072881 |
---|---|
Provider Name | Mrs. Shannon Leigh Taylor |
First Address | Little Rock, AR 72205-7202 |
Second Address | Little Rock, AR 72205-7202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 29/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
152424721 | (05) | AR |