Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 05085 | MD |
N | 225XE0001X | Environmental Modification | 05085 | MD |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 05085 | MD |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 05085 | MD |
NPI | 1639373145 |
---|---|
Provider Name | Ms. Jennifer Dionne Taylor |
First Address | Glen Burnie, MD 21060-7026 |
Second Address | Glen Burnie, MD 21061-2566 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 24/03/2021 |