Provider Demographics
NPI:1497333173
Name:COATS, TARA JEAN (COTA/L)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:JEAN
Last Name:COATS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1174 160TH ST
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:IA
Mailing Address - Zip Code:52347-8558
Mailing Address - Country:US
Mailing Address - Phone:319-430-1367
Mailing Address - Fax:
Practice Address - Street 1:500 1ST ST N
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3119
Practice Address - Country:US
Practice Address - Phone:641-791-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00364224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant