Provider Demographics
NPI:1821893199
Name:FRESH, TARA JEANNE (OTR/L)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:JEANNE
Last Name:FRESH
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 1:1722 MILL RD
Mailing Address - Street 2:
Mailing Address - City:UPPER CHICHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19061-3249
Mailing Address - Country:US
Mailing Address - Phone:215-499-5448
Mailing Address - Fax:
Practice Address - Street 1:900 N ATWATER DR
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-0078
Practice Address - Country:US
Practice Address - Phone:855-657-8723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XP0019X
PAOC018502225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation