Provider Demographics
NPI:1013444926
Name:LEWIS, TARA ANNE (MOT, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:ANNE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:ANNE
Other - Last Name:DEHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:9 WEPAWAUG DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-1916
Mailing Address - Country:US
Mailing Address - Phone:203-535-2336
Mailing Address - Fax:
Practice Address - Street 1:130 LEEDER HILL DR
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517-2730
Practice Address - Country:US
Practice Address - Phone:203-281-3577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004578225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist