Provider Demographics
NPI:1104667658
Name:TAYLOR, LAUREL ANN (OTR/L)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LAUREL
Other - Middle Name:ANN
Other - Last Name:BRAGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:7602 CHAPMAN RD
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21087-1532
Mailing Address - Country:US
Mailing Address - Phone:443-791-2110
Mailing Address - Fax:
Practice Address - Street 1:8820 WALTHER BLVD
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-9025
Practice Address - Country:US
Practice Address - Phone:410-657-3593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06981225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist