Provider Demographics
NPI:1861110785
Name:CALEB- TAYLOR, BRITTANY (MOTR/L)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:CALEB- TAYLOR
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 MOSE DR
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-1211
Mailing Address - Country:US
Mailing Address - Phone:931-738-9430
Mailing Address - Fax:
Practice Address - Street 1:508 MOSE DR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-1211
Practice Address - Country:US
Practice Address - Phone:931-738-9430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119009407225X00000X
TN7527225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty