Provider Demographics
NPI:1558424598
Name:CARLONI, TARA (OT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:CARLONI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2000 MEDICAL PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3742
Mailing Address - Country:US
Mailing Address - Phone:410-268-8862
Mailing Address - Fax:410-280-4701
Practice Address - Street 1:8638 VETERANS HWY
Practice Address - Street 2:1ST FLOOR
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-1422
Practice Address - Country:US
Practice Address - Phone:410-729-4508
Practice Address - Fax:410-729-4526
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD04668225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist