Healthcare Provider Details

I. General information

NPI: 1932527488
Provider Name (Legal Business Name): TARA MIZNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 ASHLAND ST
LOUISVILLE OH
44641-9031
US

IV. Provider business mailing address

209 10TH ST NE
NORTH CANTON OH
44720-2020
US

V. Phone/Fax

Practice location:
  • Phone: 330-479-3440
  • Fax:
Mailing address:
  • Phone: 330-494-2544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA-01614
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT. 008128
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: