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General NPI Number Information
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NPI Number | 1043742182
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Entity Type | Individual
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Provider Name | TARA HANLEY OTR
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Gender | Female
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Dates
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Enumeration Date | 03/29/2017
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 10945 207TH ST
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City | QUEENS VILLAGE
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State | NY
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Zip | 11429-1411
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Country | US
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Telephone | 718-740-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 GALLBERRY LN
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City | WAXHAW
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State | NC
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Zip | 28173-0161
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Country | US
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Telephone | 929-990-7660
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 021316-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 17674
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License Number State | NC
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