Provider Demographics
NPI:1942577564
Name:KULAK, TARA L
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:L
Last Name:KULAK
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 1:555 HYETTS CORNER RD
Mailing Address - Street 2:COST RECOVERY
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-8907
Mailing Address - Country:US
Mailing Address - Phone:302-449-3603
Mailing Address - Fax:
Practice Address - Street 1:318 E BASIN RD
Practice Address - Street 2:COLONIAL SCHOOL DISTRICT
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-4214
Practice Address - Country:US
Practice Address - Phone:302-323-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU1-0001269225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist