Provider Demographics
NPI:1477177178
Name:BUOL, TARIN (MSOT)
Entity Type:Individual
Prefix:
First Name:TARIN
Middle Name:
Last Name:BUOL
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 1:3113 W BELTLINE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2934
Mailing Address - Country:US
Mailing Address - Phone:608-819-6810
Mailing Address - Fax:224-258-1400
Practice Address - Street 1:3113 W BELTLINE HWY STE 300
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-2934
Practice Address - Country:US
Practice Address - Phone:608-819-6810
Practice Address - Fax:224-258-1400
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI437271225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist