Basic Information
| Provider Information | |||||||||
| NPI: | 1063708303 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAILOR | ||||||||
| FirstName: | BADRASHILA | ||||||||
| MiddleName: | |||||||||
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| Credential: | OTR/L | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | TAILOR | ||||||||
| OtherFirstName: | SHEILA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | OTR/L | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8110 SAINT MARLO COUNTRY CLUB PKWY | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300971625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4045136192 | ||||||||
| FaxNumber: | 7709959604 | ||||||||
| Practice Location | |||||||||
| Address1: | 8110 SAINT MARLO COUNTRY CLUB PKWY | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300971625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4045136192 | ||||||||
| FaxNumber: | 7709959604 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2011 | ||||||||
| LastUpdateDate: | 06/24/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT000727 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.