Provider Demographics
NPI:1295384196
Name:CATES, TARA DIANE
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:DIANE
Last Name:CATES
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 1:1496 BAXTER HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:TN
Mailing Address - Zip Code:37306-2309
Mailing Address - Country:US
Mailing Address - Phone:931-691-9476
Mailing Address - Fax:
Practice Address - Street 1:1496 BAXTER HOLLOW RD
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:TN
Practice Address - Zip Code:37306-2309
Practice Address - Country:US
Practice Address - Phone:931-691-9476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer