Provider Demographics
NPI:1356913222
Name:TAYLOR, TREVOR ALEXANDER (OTR/L)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:ALEXANDER
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 NEWLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02019-1934
Mailing Address - Country:US
Mailing Address - Phone:508-369-2502
Mailing Address - Fax:
Practice Address - Street 1:140 GOULD ST STE 290
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-2397
Practice Address - Country:US
Practice Address - Phone:617-610-6408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7621225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty