MEDICARE: TARA G MCCANN MSOT

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	225X00000X	Occupational Therapist	1032940	OR

Other Identifiers

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

General Provider Information

NPI Number	:	1871563783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA G MCCANN MSOT

Provider Business Mailing Address
First Line	:	6430 SE JENNINGS AVE
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97267-6317
Country	:	US
Telephone Number	:	360-907-5874
Fax Number	:

Provider Business Practice Location Address
First Line	:	7927 SE ORIENT DR
Second Line	:
City	:	GRESHAM
State	:	OR
Zip	:	97080
Country	:	US
Telephone Number	:	503-663-0332
Fax Number	:	503-663-1114

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	07/09/2007

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Directions to “ TARA G MCCANN MSOT” Practice Location

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