Individual
TARA LINETTE MCCORMICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTD, OTRL
Contact information
Practice address
1178B RIVER HWY STE 100, MOORESVILLE, NC 28117-9064
(508) 243-2433
Mailing address
4990 KISER ISLAND RD, TERRELL, NC 28682-9773
(508) 243-2433
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2096
NC
225XP0200X
Pediatric Occupational Therapist
OTL5915
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT0174
BLUECROSS BLUE SHIELD
MA
Enumeration date
03/14/2007
Last updated
07/11/2025
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