Provider Demographics
NPI:1649539776
Name:SMITH, TARA JANINE (MS OTR/L)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:JANINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 SCRIBNER AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-2536
Mailing Address - Country:US
Mailing Address - Phone:203-515-0444
Mailing Address - Fax:
Practice Address - Street 1:65 SCRIBNER AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-2536
Practice Address - Country:US
Practice Address - Phone:203-515-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003832225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist