Provider Demographics
NPI:1962659078
Name:KOLODEY, TARA ORLENA TAPP (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:ORLENA TAPP
Last Name:KOLODEY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 SOUTH BERNARD STREET
Mailing Address - Street 2:
Mailing Address - City:NEBO
Mailing Address - State:KY
Mailing Address - Zip Code:42441
Mailing Address - Country:US
Mailing Address - Phone:270-871-0446
Mailing Address - Fax:
Practice Address - Street 1:419 N SEMINARY ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1515
Practice Address - Country:US
Practice Address - Phone:270-821-5564
Practice Address - Fax:270-821-6211
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA2847224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant