Basic Information
| Provider Information | |||||||||
| NPI: | 1831866060 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOMIS | ||||||||
| FirstName: | TAYLOR | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2133 KING JAMES DR | ||||||||
| Address2: | |||||||||
| City: | GREEN BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 543041830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9206349665 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5778 CHAPIN ST | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 541219443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7155284833 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2021 | ||||||||
| LastUpdateDate: | 08/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.