Provider Demographics
NPI:1194076315
Name:CARROLL, TARA A (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:A
Last Name:CARROLL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 S 64TH PLZ APT 104
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2878
Mailing Address - Country:US
Mailing Address - Phone:024-990-3191
Mailing Address - Fax:
Practice Address - Street 1:2120 S 64TH PLZ APT 104
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-2878
Practice Address - Country:US
Practice Address - Phone:402-990-3191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE634225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist