Healthcare Provider Details

I. General information

NPI: 1114377504
Provider Name (Legal Business Name): TARA HEPLER SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8139 LEE DAVIS RD
MECHANICSVILLE VA
23111-7001
US

IV. Provider business mailing address

16 N VINE ST APT 103
RICHMOND VA
23220-4565
US

V. Phone/Fax

Practice location:
  • Phone: 804-559-5030
  • Fax:
Mailing address:
  • Phone: 804-938-5332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202006244
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: