Provider Demographics
NPI:1255622114
Name:WHALEN, TARA-RENEE (OTD OTR/L IBCLC NLP)
Entity type:Individual
Prefix:DR
First Name:TARA-RENEE
Middle Name:
Last Name:WHALEN
Suffix:
Gender:F
Credentials:OTD OTR/L IBCLC NLP
Other - Prefix:DR
Other - First Name:TARA-RENEE
Other - Middle Name:
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD, OTR/L
Mailing Address - Street 1:1401 S BERETANIA ST STE 370
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1871
Mailing Address - Country:US
Mailing Address - Phone:808-369-9090
Mailing Address - Fax:808-369-9087
Practice Address - Street 1:1401 S BERETANIA ST STE 370
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1871
Practice Address - Country:US
Practice Address - Phone:808-369-9090
Practice Address - Fax:808-369-9087
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-309686174N00000X
WA60075291225X00000X
AK100574225X00000X
CA11769225XP0200X
HIOT-2077-0225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist