Provider Demographics
NPI:1538465653
Name:ACTON, TARA JILL (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:JILL
Last Name:ACTON
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 1:1130 W DIMOND BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-1511
Mailing Address - Country:US
Mailing Address - Phone:205-919-2228
Mailing Address - Fax:
Practice Address - Street 1:1130 W DIMOND BLVD STE B
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-1511
Practice Address - Country:US
Practice Address - Phone:205-919-2228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPHYO2055225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist