Healthcare Provider Details

I. General information

NPI: 1588359517
Provider Name (Legal Business Name): TARA OHRT PHD, HSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 5TH ST STE 202
CORALVILLE IA
52241-2939
US

IV. Provider business mailing address

1303 5TH ST STE 202
CORALVILLE IA
52241-2939
US

V. Phone/Fax

Practice location:
  • Phone: 319-358-6520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number110723
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: