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NPI Code Detail

MEDICARE: TARA A JOSEPH OT

MEDICARE: TARA A JOSEPH OT
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 Therapist013917-1NY

General Provider Information

NPI Number : 1467418988
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA A JOSEPH OT
Provider Business Mailing Address
First Line : 30 SOUTHGATE RD
Second Line :
City : LOUDONVILLE
State : NY
Zip : 12211-1132
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 30 SOUTHGATE RD
Second Line :
City : LOUDONVILLE
State : NY
Zip : 12211-1132
Country : US
Telephone Number : 518-785-6607
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2006
Last Update Date : 02/15/2012

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