Provider Demographics
NPI:1124609714
Name:HARTGRAVES, TAYLOR GRACE (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:GRACE
Last Name:HARTGRAVES
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8959 RIVER TRAILS BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76118-7719
Mailing Address - Country:US
Mailing Address - Phone:214-729-0562
Mailing Address - Fax:
Practice Address - Street 1:6601 HARRIS PKWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-6108
Practice Address - Country:US
Practice Address - Phone:817-738-9866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120212225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist