Provider Demographics
NPI:1861049504
Name:CANTOR, KAREN LESLIE TAYLOR
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LESLIE TAYLOR
Last Name:CANTOR
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 1:1406 MARTINEZ DR
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-8755
Mailing Address - Country:US
Mailing Address - Phone:716-863-4040
Mailing Address - Fax:
Practice Address - Street 1:4725 BELLWETHER LN
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:FL
Practice Address - Zip Code:34484-2980
Practice Address - Country:US
Practice Address - Phone:353-430-0076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14691225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist