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NPI Code Detail

MEDICARE: MS. TARA TRAVERS DEMORATZ CCC-SLP

MEDICARE: MS. TARA TRAVERS DEMORATZ CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist2202003109VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033204078
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TARA TRAVERS DEMORATZ CCC-SLP
Provider Business Mailing Address
First Line : 2924 BROOK RD
Second Line :
City : RICHMOND
State : VA
Zip : 23220-1215
Country : US
Telephone Number : 804-614-2452
Fax Number :
Provider Business Practice Location Address
First Line : 2924 BROOK RD
Second Line :
City : RICHMOND
State : VA
Zip : 23220-1215
Country : US
Telephone Number : 804-614-2452
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 10/08/2024

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