Provider Demographics
NPI:1104623875
Name:TAYLOR, SUSAN RAMIREZ (COTA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:RAMIREZ
Last Name:TAYLOR
Suffix:
Gender:
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18342 E WOODCROFT ST
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-5842
Mailing Address - Country:US
Mailing Address - Phone:626-621-7397
Mailing Address - Fax:
Practice Address - Street 1:943 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-2046
Practice Address - Country:US
Practice Address - Phone:626-671-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7078224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant