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NPI Code Detail

MEDICARE: MS. TARA IDA RENEE PETERS OTR/L

MEDICARE: MS. TARA IDA RENEE PETERS OTR/L
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
1225X00000XOccupational TherapistOT.007531OH

General Provider Information

NPI Number : 1295048544
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TARA IDA RENEE PETERS OTR/L
Provider Business Mailing Address
First Line : 14735 SADDLEBROOK CT
Second Line :
City : PERRYSBURG
State : OH
Zip : 43551-6780
Country : US
Telephone Number : 419-302-8419
Fax Number :
Provider Business Practice Location Address
First Line : 2275 COLLINGWOOD BLVD
Second Line :
City : TOLEDO
State : OH
Zip : 43620-1100
Country : US
Telephone Number : 419-245-4150
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2010
Last Update Date : 03/06/2023

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