Healthcare Provider Details

I. General information

NPI: 1780553594
Provider Name (Legal Business Name): CARYN TABOR MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 FLAT TOP RD
SHADY SPRING WV
25918-8619
US

IV. Provider business mailing address

734 FLAT TOP RD
SHADY SPRING WV
25918-8619
US

V. Phone/Fax

Practice location:
  • Phone: 304-575-8755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: