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General NPI Number Information
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NPI Number | 1215141866
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Entity Type | Individual
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Provider Name | TARA L. BYCROFT OT
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Gender | Female
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1995 E STATE ST
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City | SALEM
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State | OH
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Zip | 44460-2423
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Country | US
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Telephone | 330-332-7297
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Fax |
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Provider Business Mailing Address
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Address Line | 1393 RAUCH RD
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City | EAST PALESTINE
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State | OH
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Zip | 44413-9795
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Country | US
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Telephone | 330-426-3871
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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-005199
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License Number State | OH
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