Provider Demographics
NPI:1790949659
Name:RAY, TARA LEIGH (MOT, OTR)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LEIGH
Last Name:RAY
Suffix:
Gender:F
Credentials:MOT, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6439 WATERCREST WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1985
Mailing Address - Country:US
Mailing Address - Phone:317-293-1981
Mailing Address - Fax:
Practice Address - Street 1:1001 N GRANT ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-1944
Practice Address - Country:US
Practice Address - Phone:765-482-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004007A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist