Provider Demographics
NPI:1386758811
Name:TAYLOR, LEANNE ELIZABETH (OTR)
Entity type:Individual
Prefix:MS
First Name:LEANNE
Middle Name:ELIZABETH
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:AZ
Mailing Address - Zip Code:85173-3408
Mailing Address - Country:US
Mailing Address - Phone:520-689-2194
Mailing Address - Fax:
Practice Address - Street 1:6595 N ORACLE RD
Practice Address - Street 2:SUITE 109
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5645
Practice Address - Country:US
Practice Address - Phone:520-229-8460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0549225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ107843Medicare UPIN