Provider Demographics
NPI:1851673891
Name:HOLTZMAN-BALL, TARA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:HOLTZMAN-BALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LIBERTY LN
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056-1446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 LIBERTY LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:MA
Practice Address - Zip Code:02056-1446
Practice Address - Country:US
Practice Address - Phone:508-613-1800
Practice Address - Fax:508-613-1806
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH25989183500000X
RIRPH04500183500000X
MA1916225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist