Provider Demographics
NPI:1467418988
Name:JOSEPH, TARA A (OT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:A
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:A
Other - Last Name:HOLLIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:30 SOUTHGATE RD
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12211-1132
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 SOUTHGATE RD
Practice Address - Street 2:
Practice Address - City:LOUDONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12211-1132
Practice Address - Country:US
Practice Address - Phone:518-785-6607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013917-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB0278Medicare PIN