Provider Demographics
NPI:1306925078
Name:TAYLOR, STACEY LYNN (PT)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:LYNN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:STACEY
Other - Middle Name:LYNN
Other - Last Name:COCHRANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5909 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-0915
Mailing Address - Country:US
Mailing Address - Phone:972-679-5874
Mailing Address - Fax:888-467-4607
Practice Address - Street 1:5909 BETHEL RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-0915
Practice Address - Country:US
Practice Address - Phone:972-679-5874
Practice Address - Fax:888-467-4607
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1168697225100000X
OK4777225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist