Individual
TARA CHRISTINE HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1215 WILDEWOOD DOWNS CIRCLE, COLUMBIA, SC 29223
(803) 788-5115
Mailing address
1175 HAYWOOD RD APT 1C, GREENVILLE, SC 29615-2264
(440) 289-1285
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5679
SC
225X00000X
Occupational Therapist
OT010579
OH
Other
Enumeration date
10/28/2019
Last updated
11/01/2019
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