Healthcare Provider Details

I. General information

NPI: 1740104967
Provider Name (Legal Business Name): TARA MORETZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 E CATAWBA ST
BELMONT NC
28012-3351
US

IV. Provider business mailing address

110A ROPER ST
BELMONT NC
28012-2119
US

V. Phone/Fax

Practice location:
  • Phone: 980-529-7623
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB2749072
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: