Healthcare Provider Details

I. General information

NPI: 1760391932
Provider Name (Legal Business Name): TARA JEAN OTERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 MAYNARD ST BUILDING 307
FORT BRAGG NC
28310
US

IV. Provider business mailing address

383 MAYNARD ST BUILDING 307
FORT BRAGG NC
28310
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-9252
  • Fax:
Mailing address:
  • Phone: 910-907-9252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: