Provider Demographics
NPI:1396945796
Name:MARLER, TARA M (COTA)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:M
Last Name:MARLER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:M
Other - Last Name:PHARES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 461
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:IA
Mailing Address - Zip Code:50201-0461
Mailing Address - Country:US
Mailing Address - Phone:515-382-3366
Mailing Address - Fax:515-382-1576
Practice Address - Street 1:612 8TH ST SW
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-2301
Practice Address - Country:US
Practice Address - Phone:515-967-4124
Practice Address - Fax:515-987-9094
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00753224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant