Basic Information
| Provider Information | |||||||||
| NPI: | 1467460378 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | RUTH | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OTR | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PURCELL | ||||||||
| OtherFirstName: | HEATHER | ||||||||
| OtherMiddleName: | TAYLOR | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | OTR | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 57 REGIONAL DR. | ||||||||
| Address2: | SUITE #7 | ||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032262900 | ||||||||
| FaxNumber: | 6032262903 | ||||||||
| Practice Location | |||||||||
| Address1: | 57 REGIONAL DR. | ||||||||
| Address2: | SUITE #7 | ||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032262900 | ||||||||
| FaxNumber: | 6032262903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 02/08/2013 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 2263 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 2779432 | 01 | CIGNA HEALTH PLAN | OTHER | OT0065 | 01 | BLUE CROSS | OTHER | 43213 | 01 | FALLON COMM HEALTH PLAN | OTHER | 0319091 | 05 | MA | MEDICAID | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 042472266 | 01 | HEALTHCARE VALUE MGMT | OTHER | 042472266 | 01 | ONE HEALTH PLAN | OTHER | AA4053 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER | 0319091 | 01 | WELFARE | OTHER | 670001299 | 01 | RAILROAD MEDICARE | OTHER | 787418 | 01 | MVP HEALTH CARE | OTHER | 7571599 | 01 | US HEALTHCARE | OTHER | Y68483 | 01 | MEDICARE B | OTHER | 042472266 | 01 | THREE RIVERS | OTHER | 7571599 | 01 | AETNA | OTHER |