Provider Demographics
NPI:1124616487
Name:CROTTS, TARA RENEE (HEARING INSTRUMENT S)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:RENEE
Last Name:CROTTS
Suffix:
Gender:F
Credentials:HEARING INSTRUMENT S
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:RENEE
Other - Last Name:KIVETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HEARING INSTRUMENT S
Mailing Address - Street 1:423 SOUTH KING STREET
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655
Mailing Address - Country:US
Mailing Address - Phone:828-438-9685
Mailing Address - Fax:828-391-5024
Practice Address - Street 1:423 SOUTH KING STREET
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655
Practice Address - Country:US
Practice Address - Phone:828-438-9685
Practice Address - Fax:828-391-5024
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1178A01237700000X
NC1635237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist