Provider Demographics
NPI:1225321714
Name:OTT, TARYN R (LMT)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:R
Last Name:OTT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14661 139TH LOOP
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32060-6597
Mailing Address - Country:US
Mailing Address - Phone:386-365-8537
Mailing Address - Fax:386-776-4165
Practice Address - Street 1:14661 139TH LOOP
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32060-6597
Practice Address - Country:US
Practice Address - Phone:386-365-8537
Practice Address - Fax:410-861-6262
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 58172225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist