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NPI Code Detail

MEDICARE: MS. TARA DORINDA MCCLAIN

MEDICARE: MS. TARA DORINDA MCCLAIN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerI-0600122OH

General Provider Information

NPI Number : 1215395504
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TARA DORINDA MCCLAIN
Provider Business Mailing Address
First Line : 2440 DAWNLIGHT AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43211-1934
Country : US
Telephone Number : 614-314-4391
Fax Number :
Provider Business Practice Location Address
First Line : 2440 DAWNLIGHT AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43211-1934
Country : US
Telephone Number : 614-314-4391
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2016
Last Update Date : 02/02/2016

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