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General NPI Number Information
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NPI Number | 1114521481
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Entity Type | Individual
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Provider Name | TARINAH JOY FAIRCLOTH-CHIN
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Gender | Female
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Dates
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Enumeration Date | 11/25/2020
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 1107 MAGGIE RD
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City | NEWBURGH
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State | NY
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Zip | 12550-7018
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Country | US
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Telephone | 845-240-9999
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 749
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City | BELMONT
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State | NC
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Zip | 28012-0749
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Country | US
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Telephone | 704-869-2088
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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 | 15018
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License Number State | NC
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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 | 025247
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License Number State | NY
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