Provider Demographics
NPI:1831165810
Name:HORNER-VAN VOORHIS, TARA JOY (PT)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:JOY
Last Name:HORNER-VAN VOORHIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWCOMERSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43832-1042
Mailing Address - Country:US
Mailing Address - Phone:740-498-8551
Mailing Address - Fax:740-498-4754
Practice Address - Street 1:223 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWCOMERSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43832-1042
Practice Address - Country:US
Practice Address - Phone:740-498-8551
Practice Address - Fax:740-498-4754
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT09091174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2459601Medicaid
OH4103651Medicare ID - Type Unspecified