Provider Demographics
NPI:1336651934
Name:TARTER, WINNIE L (COTA/L)
Entity Type:Individual
Prefix:
First Name:WINNIE
Middle Name:L
Last Name:TARTER
Suffix:
Gender:F
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 1:616 DRUMMOND WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRDALE
Mailing Address - State:KY
Mailing Address - Zip Code:40118-9632
Mailing Address - Country:US
Mailing Address - Phone:502-414-1707
Mailing Address - Fax:
Practice Address - Street 1:616 DRUMMOND WAY
Practice Address - Street 2:
Practice Address - City:FAIRDALE
Practice Address - State:KY
Practice Address - Zip Code:40118-9632
Practice Address - Country:US
Practice Address - Phone:502-492-9452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-04
Last Update Date:2017-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY161877224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant