Provider Demographics
NPI:1972588093
Name:TAYROSE, SHEILA (OTR/L LPA)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:TAYROSE
Suffix:
Gender:F
Credentials:OTR/L LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 TRAIL TWENTY THREE ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5156
Mailing Address - Country:US
Mailing Address - Phone:919-493-5385
Mailing Address - Fax:
Practice Address - Street 1:3602 TRAIL TWENTY THREE ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5156
Practice Address - Country:US
Practice Address - Phone:919-493-5385
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC177225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7382242Medicaid
NC82242OtherBCBSNC
NC60054OtherAETNA
NCH238427OtherMAMSI
NCH238427OtherMAMSI