Provider Demographics
NPI:1275124265
Name:TABOR, PAIGE (MOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:
Last Name:TABOR
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 FIVE OAKS LN
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-0300
Mailing Address - Country:US
Mailing Address - Phone:662-418-1678
Mailing Address - Fax:
Practice Address - Street 1:1411 HIGHWAY 389
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-8451
Practice Address - Country:US
Practice Address - Phone:662-769-4888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT-3844225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist