Provider Demographics
NPI:1538787254
Name:FOURACRE, TAYLOR GRACE
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:GRACE
Last Name:FOURACRE
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 1:1225 N ASHBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-3724
Mailing Address - Country:US
Mailing Address - Phone:610-389-4226
Mailing Address - Fax:
Practice Address - Street 1:3874 UPPER KING RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-6042
Practice Address - Country:US
Practice Address - Phone:302-697-3205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU1-0002083225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist