Taylor Tidwell Wallace, OTR/L, RN

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

6039 Issued in AL

Practice address

2904 S Wilson Dam Rd
Muscle Shoals, AL 35661-3752

Phone

(256) 856-5800

NPI assigned

May 5, 2025

Last updated

May 5, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Taylor Grace Tidwell Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1746403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746403200000",
    "number": "1427847466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 W BRIGHTON AVE",
            "city": "MUSCLE SHOALS",
            "state": "AL",
            "postal_code": "356613201",
            "telephone_number": "256-762-5576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2904 S WILSON DAM RD",
            "city": "MUSCLE SHOALS",
            "state": "AL",
            "postal_code": "356613752",
            "telephone_number": "256-856-5800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "TAYLOR",
        "middle_name": "TIDWELL",
        "credential": "OTR/L, RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-05-05",
        "last_updated": "2025-05-05",
        "certification_date": "2025-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "AL",
            "license": "6039",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TAYLOR",
            "last_name": "TIDWELL",
            "middle_name": "GRACE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Occupational Therapist in Muscle Shoals, AL
• Providers in Muscle Shoals, AL by specialty
• Occupational Therapist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.