Provider Demographics
NPI:1508579079
Name:WOODARD, TAMAR (COTA/L)
Entity Type:Individual
Prefix:
First Name:TAMAR
Middle Name:
Last Name:WOODARD
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 1:2284 JON CHRIS DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-9633
Mailing Address - Country:US
Mailing Address - Phone:704-773-8995
Mailing Address - Fax:
Practice Address - Street 1:4123 KUYKENDALL RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-4449
Practice Address - Country:US
Practice Address - Phone:704-708-9931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15053224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant