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General NPI Number Information
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NPI Number | 1558946566
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Entity Type | Individual
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Provider Name | TARA KRISTEN LANG OTR/L
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Gender | Female
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Dates
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Enumeration Date | 03/11/2021
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Last Update Date | 03/11/2021
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Provider Practice Location Address
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Address Line | 300 CENTER AVE
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City | WAYNESBURG
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State | PA
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Zip | 15370-8243
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Country | US
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Telephone | 724-852-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 14 JORDAN LN
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City | MORGANTOWN
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State | WV
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Zip | 26501-2071
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Country | US
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Telephone | 304-290-4852
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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 | OC017546
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License Number State | PA
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