Provider Demographics
NPI:1710860846
Name:WATSON, TAYLOR
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8781 COUNTY ROAD 629
Mailing Address - Street 2:
Mailing Address - City:QULIN
Mailing Address - State:MO
Mailing Address - Zip Code:63961-8226
Mailing Address - Country:US
Mailing Address - Phone:573-429-1373
Mailing Address - Fax:
Practice Address - Street 1:601 W BURKHART ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MO
Practice Address - Zip Code:63863-1440
Practice Address - Country:US
Practice Address - Phone:573-276-5794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024044474224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant