Provider Demographics
NPI:1447941703
Name:TAYLOR, JILLIAN (OT, OTR)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:OT, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W CLARENDON AVE STE 285
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3474
Mailing Address - Country:US
Mailing Address - Phone:602-279-6905
Mailing Address - Fax:
Practice Address - Street 1:1489 S HIGLEY RD STE 103
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-5049
Practice Address - Country:US
Practice Address - Phone:480-750-1974
Practice Address - Fax:480-361-6668
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-009164225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist