Provider Demographics
NPI:1285034793
Name:BERNARD, TARALYN
Entity Type:Individual
Prefix:
First Name:TARALYN
Middle Name:
Last Name:BERNARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6099 MT MORIAH RD EXT
Mailing Address - Street 2:SUITE 3M
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-0313
Mailing Address - Country:US
Mailing Address - Phone:901-864-4030
Mailing Address - Fax:888-252-7902
Practice Address - Street 1:6099 MT MORIAH RD EXT
Practice Address - Street 2:SUITE 3M
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-0313
Practice Address - Country:US
Practice Address - Phone:901-864-4030
Practice Address - Fax:888-252-7902
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002114225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3655612Medicaid
3655612Medicare Oscar/Certification