Provider Demographics
NPI:1194403444
Name:FORNEY, TAYLOR MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MARIE
Last Name:FORNEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 THOMASBORO RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY FORD
Mailing Address - State:GA
Mailing Address - Zip Code:30455-7317
Mailing Address - Country:US
Mailing Address - Phone:912-682-3740
Mailing Address - Fax:
Practice Address - Street 1:817 CRAWFORD AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-3772
Practice Address - Country:US
Practice Address - Phone:706-736-1255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT008886225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist