Provider Demographics
NPI:1356591689
Name:DURKIN D ANGELO, TARA (OT)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:DURKIN D ANGELO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:ANNE
Other - Last Name:D'ANGELO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT
Mailing Address - Street 1:638 BRANDYWINE PKWY
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4278
Mailing Address - Country:US
Mailing Address - Phone:610-436-3600
Mailing Address - Fax:
Practice Address - Street 1:638 BRANDYWINE PKWY
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4278
Practice Address - Country:US
Practice Address - Phone:610-436-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC007328225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist