Provider Demographics
NPI:1427455658
Name:SHOUN, TAYLOR (COTA/L)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:SHOUN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANA
Mailing Address - State:PA
Mailing Address - Zip Code:17509-1305
Mailing Address - Country:US
Mailing Address - Phone:610-593-6901
Mailing Address - Fax:610-593-0243
Practice Address - Street 1:41 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:CHRISTIANA
Practice Address - State:PA
Practice Address - Zip Code:17509-1305
Practice Address - Country:US
Practice Address - Phone:610-593-6901
Practice Address - Fax:610-593-0243
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU2-0001524224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant