Provider Demographics
NPI:1649751819
Name:TARA C. CARLSON, OTR, LLC
Entity Type:Organization
Organization Name:TARA C. CARLSON, OTR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:303-587-5526
Mailing Address - Street 1:2127 GRAYDEN CT
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-8223
Mailing Address - Country:US
Mailing Address - Phone:303-587-5526
Mailing Address - Fax:
Practice Address - Street 1:2127 GRAYDEN CT
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027-8223
Practice Address - Country:US
Practice Address - Phone:303-587-5526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002418225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty