Provider Demographics
NPI:1013663475
Name:HOLDEN, TAYLOR H (OT)
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:H
Last Name:HOLDEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:TAYLOR
Other - Middle Name:A
Other - Last Name:HARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11315 MCCORMICK RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002
Mailing Address - Country:US
Mailing Address - Phone:901-461-7633
Mailing Address - Fax:901-867-1603
Practice Address - Street 1:1751 DANCY BLVD
Practice Address - Street 2:STE 2
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637
Practice Address - Country:US
Practice Address - Phone:901-292-5313
Practice Address - Fax:901-867-1603
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6986225X00000X
MSOT-4037225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS200004286Medicaid