Provider Demographics
NPI:1104033430
Name:SWEENEY, TARA ELIZABETH (COTA)
Entity type:Individual
Prefix:MISS
First Name:TARA
Middle Name:ELIZABETH
Last Name:SWEENEY
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 1:75 DONALD ST APT 38
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02188-3917
Mailing Address - Country:US
Mailing Address - Phone:781-812-3375
Mailing Address - Fax:
Practice Address - Street 1:640 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1116
Practice Address - Country:US
Practice Address - Phone:617-497-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2873224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant