Provider Demographics
NPI:1982067104
Name:TAYLOR, JAMIE D'ANN (OT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:D'ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 REDMOND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-2745
Mailing Address - Country:US
Mailing Address - Phone:408-323-1013
Mailing Address - Fax:408-323-1013
Practice Address - Street 1:1227 REDMOND AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-2745
Practice Address - Country:US
Practice Address - Phone:408-323-1013
Practice Address - Fax:408-323-1013
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13001225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist