Provider Demographics
NPI:1528365020
Name:BURROWS, TARA TRIEST (OTR/L)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:TRIEST
Last Name:BURROWS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 SE TEMPEST DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1802
Mailing Address - Country:US
Mailing Address - Phone:510-898-8820
Mailing Address - Fax:
Practice Address - Street 1:2125 NE DAGGETT LN
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6560
Practice Address - Country:US
Practice Address - Phone:541-389-1848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X
OR399535225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No372600000XNursing Service Related ProvidersAdult Companion