Healthcare Provider Details

I. General information

NPI: 1235927914
Provider Name (Legal Business Name): TARA WILMOTH LMT, CD (DONA)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

443 RAUPP BLVD
BUFFALO GROVE IL
60089-3403
US

IV. Provider business mailing address

443 RAUPP BLVD
BUFFALO GROVE IL
60089-3403
US

V. Phone/Fax

Practice location:
  • Phone: 312-890-2318
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227016838
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number15488
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: