Provider Demographics
NPI:1871361931
Name:JOHNSON, TAYLOR L (OTRL)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2753 N IDA LINDSEY DR APT 9
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4486
Mailing Address - Country:US
Mailing Address - Phone:831-601-4612
Mailing Address - Fax:
Practice Address - Street 1:2753 N IDA LINDSEY DR APT 9
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4486
Practice Address - Country:US
Practice Address - Phone:831-601-4612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3079225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist