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NPI Code Detail

MEDICARE: TARA EVERITT OCCUPATIONAL THERAPI

MEDICARE: TARA EVERITT OCCUPATIONAL THERAPI
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 Therapist0TR1158AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15U882OTHERARBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1619032588
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA EVERITT OCCUPATIONAL THERAPI
Provider Business Mailing Address
First Line : 4901 N SHORE DR
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72118-5293
Country : US
Telephone Number : 501-791-3331
Fax Number : 501-791-0294
Provider Business Practice Location Address
First Line : 4901 N SHORE DR
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72118-5293
Country : US
Telephone Number : 501-791-3331
Fax Number : 501-791-0294
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2006
Last Update Date : 07/08/2007

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Directions to “ TARA EVERITT OCCUPATIONAL THERAPI” Practice Location

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