Provider Demographics
NPI:1497076707
Name:DRISCOL, TARA ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:ANN
Last Name:DRISCOL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:TARA
Other - Middle Name:ANN
Other - Last Name:SPAUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1208 SHEFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-1047
Mailing Address - Country:US
Mailing Address - Phone:847-975-3367
Mailing Address - Fax:
Practice Address - Street 1:1501 BUSCH PKWY
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-2686
Practice Address - Country:US
Practice Address - Phone:847-419-7150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016251283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital