Individual
MS. TARA TRAVERS DEMORATZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
2924 BROOK RD, RICHMOND, VA 23220-1215
(804) 614-2452
Mailing address
2924 BROOK RD, RICHMOND, VA 23220-1215
(804) 614-2452
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202003109
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008949166
—
VA
Enumeration date
10/04/2006
Last updated
10/08/2024
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