Provider Demographics
NPI:1568724169
Name:CORDY, TARA (MSED, SBL,SDL)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:CORDY
Suffix:
Gender:F
Credentials:MSED, SBL,SDL
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:CORDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3837 TURTLE RUN BLVD APT 2527
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4265
Mailing Address - Country:US
Mailing Address - Phone:917-374-7809
Mailing Address - Fax:
Practice Address - Street 1:3837 TURTLE RUN BLVD APT 2527
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-4265
Practice Address - Country:US
Practice Address - Phone:917-374-7809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No174400000XOther Service ProvidersSpecialist