Provider Demographics
NPI:1437114949
Name:WARWICK, TARA RENEE (OTR/L)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:RENEE
Last Name:WARWICK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30034
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-0001
Mailing Address - Country:US
Mailing Address - Phone:405-503-6639
Mailing Address - Fax:866-435-3297
Practice Address - Street 1:9636 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-2727
Practice Address - Country:US
Practice Address - Phone:405-503-6639
Practice Address - Fax:866-435-3297
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOT 1098225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100638220Medicaid