Provider Demographics
NPI:1407095623
Name:RAINER, TARA KIM (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:KIM
Last Name:RAINER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:KIM
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2721 LEE PLACE
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710
Mailing Address - Country:US
Mailing Address - Phone:516-572-6154
Mailing Address - Fax:516-572-5793
Practice Address - Street 1:NASSAU UNIVERSITY MEDICAL CENTER
Practice Address - Street 2:2201 HEMPSTEAD TURNPIKE
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554
Practice Address - Country:US
Practice Address - Phone:516-572-6154
Practice Address - Fax:516-572-5793
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015351225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY015351OtherNYS LICENSE #