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TARA FOX MOT OTRL
Pediatrics >> Occupational Therapist >> Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRegistrant NPI Number: 1588654537
Individual Registrant: TARA FOX MOT OTRL
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
156 SHADOW WOOD BND ST SIMONS ISLAND, GA 31522-5713 US
Tel: 678-333-5832 Fax: --
Tel: 678-333-5832 Fax: --
Contact information for business:
156 SHADOW WOOD BND ST SIMONS ISLAND, GA 31522-5713 US
Tel: 678-333-5832 Fax: --
Tel: 678-333-5832 Fax: --
Registration Information:
NPI: 1588654537
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Occupational Therapist Pediatrics | GA | OT004571 |
| N | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Occupational Therapist | FL | OT 11705 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 890417100 | FL | 05 |
