Provider Demographics
NPI:1386867984
Name:BROCK, TARA TURNER (OTR)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:TURNER
Last Name:BROCK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:CORENE
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:4440 CARVER WOODS DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5529
Mailing Address - Country:US
Mailing Address - Phone:513-791-5688
Mailing Address - Fax:
Practice Address - Street 1:4440 CARVER WOODS DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-5529
Practice Address - Country:US
Practice Address - Phone:513-791-5688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH005933225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist