Provider Demographics
NPI:1457788879
Name:KALTENBAUGH, TARAN MARIE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:TARAN
Middle Name:MARIE
Last Name:KALTENBAUGH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MISS
Other - First Name:TARAN
Other - Middle Name:MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:719 N ADAIR ST
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-1218
Mailing Address - Country:US
Mailing Address - Phone:918-915-0752
Mailing Address - Fax:
Practice Address - Street 1:1505 E STEVE OWENS BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354
Practice Address - Country:US
Practice Address - Phone:918-542-4101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1431224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant