MEDICARE: TARA HAN OTD, 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
1	225XP0200X	Pediatric Occupational Therapist	2024049372	MO
2	225X00000X	Occupational Therapist	2024049372	MO

General Provider Information

NPI Number	:	1639702038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA HAN OTD, OTR/L

Provider Business Mailing Address
First Line	:	4041 CHOUTEAU AVE APT 122
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1738
Country	:	US
Telephone Number	:	732-216-6745
Fax Number	:

Provider Business Practice Location Address
First Line	:	54 THE LEGENDS PKWY STE 157
Second Line	:
City	:	EUREKA
State	:	MO
Zip	:	63025-3803
Country	:	US
Telephone Number	:	636-252-4464
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2020
Last Update Date	:	03/18/2026

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