Provider Demographics
NPI:1235543406
Name:TARUVINGA, RICHARD (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:TARUVINGA
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7863 HEATHMORE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-7418
Mailing Address - Country:US
Mailing Address - Phone:678-458-8129
Mailing Address - Fax:770-774-2223
Practice Address - Street 1:7863 HEATHMORE DR
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-7418
Practice Address - Country:US
Practice Address - Phone:678-458-8129
Practice Address - Fax:770-774-2223
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA001750224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant