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General NPI Number Information
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NPI Number | 1073053476
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Entity Type | Individual
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Provider Name | TARA CRABB OTD, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 03/03/2017
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Last Update Date | 03/03/2017
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Provider Practice Location Address
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Address Line | 14391 METROPOLIS AVE ST. 101/102
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City | FORT MYERS
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State | FL
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Zip | 33912-4423
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Country | US
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Telephone | 239-561-2778
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Fax |
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Provider Business Mailing Address
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Address Line | 4120 SKYLINE BLVD APT 1
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City | CAPE CORAL
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State | FL
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Zip | 33914-5806
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Country | US
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Telephone | 239-595-3797
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT 18237
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License Number State | FL
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