Basic Information
| Provider Information | |||||||||
| NPI: | 1447506704 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | DIXON | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 428 | ||||||||
| Address2: | |||||||||
| City: | ORCHARD PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141270428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166624955 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4036 HIGHWAY 8 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | MS | ||||||||
| PostalCode: | 387328551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6628434014 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2012 | ||||||||
| LastUpdateDate: | 07/24/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT1410 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.