Provider Demographics
NPI:1588320410
Name:BROWN, TAYLOR LEE (OTR/L)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LEE
Last Name:BROWN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 CLINIC RD APT B
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-3669
Mailing Address - Country:US
Mailing Address - Phone:203-577-9789
Mailing Address - Fax:
Practice Address - Street 1:417 CLINIC RD APT B
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-3669
Practice Address - Country:US
Practice Address - Phone:203-577-9789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020008415225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist