Provider Demographics
NPI:1730281239
Name:GIESE, TARA RENEE (OT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:RENEE
Last Name:GIESE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2739 WINDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76210-1937
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3720 N JOSEY LN
Practice Address - Street 2:104
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2481
Practice Address - Country:US
Practice Address - Phone:972-394-7170
Practice Address - Fax:972-492-8065
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109778225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist