Provider Demographics
NPI:1972760114
Name:SHEARER, TARA LYN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:LYN
Last Name:SHEARER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:PARKER CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47368
Mailing Address - Country:US
Mailing Address - Phone:765-468-8280
Mailing Address - Fax:
Practice Address - Street 1:359 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:PARKER CITY
Practice Address - State:IN
Practice Address - Zip Code:47368
Practice Address - Country:US
Practice Address - Phone:765-468-8280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001591A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant