Provider Demographics
NPI:1326190901
Name:YATES, TARA DENISE II (OT)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:DENISE
Last Name:YATES
Suffix:II
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9141 S UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-1722
Mailing Address - Country:US
Mailing Address - Phone:708-423-2793
Mailing Address - Fax:
Practice Address - Street 1:E 65TH ST AT LAKE MICHIGAN
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-1395
Practice Address - Country:US
Practice Address - Phone:773-256-5799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics