Provider Demographics
NPI:1578854626
Name:ZELLER, TARA ANN (MS, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:ANN
Last Name:ZELLER
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 CORBYTON CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7517
Mailing Address - Country:US
Mailing Address - Phone:407-227-8718
Mailing Address - Fax:
Practice Address - Street 1:2605 CORBYTON CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7517
Practice Address - Country:US
Practice Address - Phone:407-227-8718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst