Provider Demographics
NPI:1881182855
Name:REX, TARA LAUREN
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LAUREN
Last Name:REX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:LAUREN
Other - Last Name:LEVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:219 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-1698
Mailing Address - Country:US
Mailing Address - Phone:419-592-0540
Mailing Address - Fax:419-784-4506
Practice Address - Street 1:219 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-1698
Practice Address - Country:US
Practice Address - Phone:419-592-0540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator