Provider Demographics
NPI:1366618555
Name:TAYLOR, RENAE ANN
Entity type:Individual
Prefix:
First Name:RENAE
Middle Name:ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RENAE
Other - Middle Name:ANN
Other - Last Name:JOHANNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:708 HILDRETH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLES CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50616-3631
Mailing Address - Country:US
Mailing Address - Phone:507-313-4404
Mailing Address - Fax:
Practice Address - Street 1:1006 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:OSAGE
Practice Address - State:IA
Practice Address - Zip Code:50461-1610
Practice Address - Country:US
Practice Address - Phone:507-313-4404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002344225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation