Provider Demographics
NPI:1679043970
Name:PHELAN, TARRA ELIZABETH (OTR)
Entity Type:Individual
Prefix:
First Name:TARRA
Middle Name:ELIZABETH
Last Name:PHELAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WOODCART LN
Mailing Address - Street 2:
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1655
Mailing Address - Country:US
Mailing Address - Phone:508-207-5970
Mailing Address - Fax:
Practice Address - Street 1:100 AMITY ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-2202
Practice Address - Country:US
Practice Address - Phone:508-207-5970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist