Provider Demographics
NPI:1508385287
Name:CUNNINGHAM, TARA (MOT, OTR/L, ATP)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MOT, OTR/L, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 HOFFNER AVE
Mailing Address - Street 2:
Mailing Address - City:BELLE ISLE
Mailing Address - State:FL
Mailing Address - Zip Code:32809-3538
Mailing Address - Country:US
Mailing Address - Phone:386-679-5450
Mailing Address - Fax:
Practice Address - Street 1:2420 HOFFNER AVE
Practice Address - Street 2:
Practice Address - City:BELLE ISLE
Practice Address - State:FL
Practice Address - Zip Code:32809-3538
Practice Address - Country:US
Practice Address - Phone:386-679-5450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12269225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT12269OtherOT LICENSE NUMBER