Provider Demographics
NPI:1770231771
Name:REID, TASHARA TIFFANY (ATC, OTR)
Entity Type:Individual
Prefix:
First Name:TASHARA
Middle Name:TIFFANY
Last Name:REID
Suffix:
Gender:F
Credentials:ATC, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3516 TALUS RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-8086
Mailing Address - Country:US
Mailing Address - Phone:910-709-6207
Mailing Address - Fax:
Practice Address - Street 1:3516 TALUS RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-8086
Practice Address - Country:US
Practice Address - Phone:910-709-6207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist