Healthcare Provider Details

I. General information

NPI: 1013872217
Provider Name (Legal Business Name): TARA ANNE MCDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1156 N BROADWAY
YONKERS NY
10701-1108
US

IV. Provider business mailing address

11 JUANA ST
TUCKAHOE NY
10707-1011
US

V. Phone/Fax

Practice location:
  • Phone: 914-965-3700
  • Fax:
Mailing address:
  • Phone: 914-776-4826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number030694
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: