Provider Demographics
NPI:1841473576
Name:HOWELL, TARA KAYE (PTA)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:KAYE
Last Name:HOWELL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:KAYE
Other - Last Name:MATTHEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6873 MERCEDES AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-2542
Mailing Address - Country:US
Mailing Address - Phone:219-763-0511
Mailing Address - Fax:219-764-4439
Practice Address - Street 1:6873 MERCEDES AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-2542
Practice Address - Country:US
Practice Address - Phone:219-763-0511
Practice Address - Fax:219-764-4439
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003499A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist