Provider Demographics
NPI:1801623830
Name:STARITA, TARA OLIVIA
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:OLIVIA
Last Name:STARITA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 BARTELL PL
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-2401
Mailing Address - Country:US
Mailing Address - Phone:732-540-9251
Mailing Address - Fax:
Practice Address - Street 1:1100 SHILOH RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-7522
Practice Address - Country:US
Practice Address - Phone:484-266-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer