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General NPI Number Information
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NPI Number | 1669896288
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Entity Type | Individual
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Provider Name | TARA LEE BLANCHARD COTA/L
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Gender | Female
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Dates
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Enumeration Date | 02/18/2014
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Last Update Date | 02/18/2014
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Provider Practice Location Address
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Address Line | 255 AVALANCHE LN
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City | DRUMS
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State | PA
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Zip | 18222-1143
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Country | US
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Telephone | 814-312-6629
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Fax |
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Provider Business Mailing Address
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Address Line | 255 AVALANCHE LN
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City | DRUMS
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State | PA
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Zip | 18222-1143
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Country | US
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Telephone | 814-312-6629
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OP006713
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License Number State | PA
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