MEDICARE: MRS. TARA CERVANO MS, OTR/L

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
1	225XP0019X	Physical Rehabilitation Occupational Therapist	46TR00890300	NJ
2	224Z00000X	Occupational Therapy Assistant	46TA09088400	NJ

General Provider Information

NPI Number	:	1740775881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TARA CERVANO MS, OTR/L

Provider Business Mailing Address
First Line	:	83 LACKAWANNA AVE APT 138
Second Line	:
City	:	WALLINGTON
State	:	NJ
Zip	:	07057-2092
Country	:	US
Telephone Number	:	845-728-8407
Fax Number	:

Provider Business Practice Location Address
First Line	:	899 PINES LAKE DR W
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-6107
Country	:	US
Telephone Number	:	201-744-5740
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2018
Last Update Date	:	09/05/2024

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