Provider Demographics
NPI:1417307323
Name:HUTTO, TARA (MSOT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:HUTTO
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 HARRETON RD
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07401-1317
Mailing Address - Country:US
Mailing Address - Phone:201-825-0660
Mailing Address - Fax:
Practice Address - Street 1:85 HARRETON RD
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:NJ
Practice Address - Zip Code:07401-1317
Practice Address - Country:US
Practice Address - Phone:201-825-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00636800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist