Provider Demographics
NPI:1588133714
Name:MARRAZZO, TAYLOR ANN (MOT LOTR)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ANN
Last Name:MARRAZZO
Suffix:
Gender:F
Credentials:MOT LOTR
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:ANN
Other - Last Name:HASTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, LOTR
Mailing Address - Street 1:17732 HIGHLAND RD, STE G, BOX 243
Mailing Address - Street 2:NA
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810
Mailing Address - Country:US
Mailing Address - Phone:225-292-4138
Mailing Address - Fax:225-636-2940
Practice Address - Street 1:18268 PETROLEUM DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-6126
Practice Address - Country:US
Practice Address - Phone:225-292-4138
Practice Address - Fax:225-636-2940
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA309232225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist