Provider Demographics
NPI:1275004632
Name:COOPER, TAYLOR WILLIAMS (OTR/L)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:WILLIAMS
Last Name:COOPER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:MARIE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3400 ANDERSON RD SUITE C
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29611
Mailing Address - Country:US
Mailing Address - Phone:846-295-9890
Mailing Address - Fax:864-295-9894
Practice Address - Street 1:511 W BUTLER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4890
Practice Address - Country:US
Practice Address - Phone:864-757-9918
Practice Address - Fax:864-757-9921
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5075225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist