Provider Demographics
NPI:1063708303
Name:TAILOR, BADRASHILA (OTR/L)
Entity type:Individual
Prefix:
First Name:BADRASHILA
Middle Name:
Last Name:TAILOR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:
Other - Last Name:TAILOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:8110 SAINT MARLO COUNTRY CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1625
Mailing Address - Country:US
Mailing Address - Phone:404-513-6192
Mailing Address - Fax:770-995-9604
Practice Address - Street 1:8110 SAINT MARLO COUNTRY CLUB PKWY
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-1625
Practice Address - Country:US
Practice Address - Phone:404-513-6192
Practice Address - Fax:770-995-9604
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT000727225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist