Individual
MRS. TARA ANN TIBBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
2817 NEW PINERY RD, PORTAGE, WI 53901-9257
(608) 745-6290
Mailing address
2817 NEW PINERY RD, PORTAGE, WI 53901-9257
(608) 745-6290
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3123-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40828300
—
WI
Enumeration date
04/14/2008
Last updated
04/14/2008
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