Provider Demographics
NPI:1477046233
Name:DIGGS, TARA K (MORT/L)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:K
Last Name:DIGGS
Suffix:
Gender:F
Credentials:MORT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 BETH ANN DR
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63389-2001
Mailing Address - Country:US
Mailing Address - Phone:573-318-4365
Mailing Address - Fax:
Practice Address - Street 1:119 BETH ANN DR
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:MO
Practice Address - Zip Code:63389-2001
Practice Address - Country:US
Practice Address - Phone:573-318-4365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO225X00000X
MO2016004144225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1477046233Medicaid