Provider Demographics
NPI:1710101498
Name:ERIKSEN, TARA (OTR)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:ERIKSEN
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 1:4440B 26TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-1201
Mailing Address - Country:US
Mailing Address - Phone:941-752-0408
Mailing Address - Fax:941-870-0876
Practice Address - Street 1:4440B 26TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-1201
Practice Address - Country:US
Practice Address - Phone:941-752-0408
Practice Address - Fax:941-870-0876
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12006225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist