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1104959428 NPI number — TARA LINETTE MCCORMICK OTD, OTRL

NPI Number: 1104959428
Health Care Provider/Practitioner: TARA LINETTE MCCORMICK OTD, OTRL

Information about “1104959428” NPI (TARA LINETTE MCCORMICK OTD, OTRL) exists in 1104959428 in HTML format HTML  |  1104959428 in plain Text format TXT  |  1104959428 in PDF (Portable Document Format) PDF  |  1104959428 in an XML format XML  formats.

NPI Number : 1104959428 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104959428",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MCCORMICK",
    "FirstName": "TARA",
    "MiddleName": "LINETTE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "OTD, OTRL",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4990 KISER ISLAND RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TERRELL",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28682-9773",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "508-243-2433",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1178B RIVER HWY STE 100",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MOORESVILLE",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28117-9064",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "508-243-2433",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/14/2007",
    "LastUpdateDate": "07/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "225XP0200X",
          "TaxonomyName": "Pediatric Occupational Therapist",
          "LicenseNumber": "OTL5915",
          "LicenseNumberStateCode": "MA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225X00000X",
          "TaxonomyName": "Occupational Therapist",
          "LicenseNumber": "2096",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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