Provider Demographics
NPI:1427222306
Name:DAVIDSON-TAYLOR, MARY-KATHERINE (MS OTR/L)
Entity type:Individual
Prefix:
First Name:MARY-KATHERINE
Middle Name:
Last Name:DAVIDSON-TAYLOR
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:MARY-KAY
Other - Middle Name:
Other - Last Name:DAVIDSON-TAYLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS OTR/L
Mailing Address - Street 1:3508 FORT HILL DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-2105
Mailing Address - Country:US
Mailing Address - Phone:703-862-6557
Mailing Address - Fax:703-329-1187
Practice Address - Street 1:3508 FORT HILL DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-2105
Practice Address - Country:US
Practice Address - Phone:703-862-6557
Practice Address - Fax:703-329-1187
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003260225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist