Provider Demographics
NPI:1194820332
Name:SANDKER, TARALYNN (MS OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:TARALYNN
Middle Name:
Last Name:SANDKER
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:TARALYNN
Other - Middle Name:AGNES
Other - Last Name:LUMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR/L
Mailing Address - Street 1:84 CHELSEA CIR
Mailing Address - Street 2:
Mailing Address - City:CLEMENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-4223
Mailing Address - Country:US
Mailing Address - Phone:573-703-5647
Mailing Address - Fax:
Practice Address - Street 1:300 FLOYD DR
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-3960
Practice Address - Country:US
Practice Address - Phone:573-472-0397
Practice Address - Fax:573-472-0406
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00472800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO477558902Medicaid