Individual
MS. TARA LYNN DIKEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED.,OTR
Contact information
Practice address
2665 A DUTTON MEADOW AVE, SANTA ROSA, CA 95407-7730
(707) 565-8185
(707) 565-8190
Mailing address
2665 A DUTTON MEADOW AVE, SANTA ROSA, CA 95407-7730
(707) 565-8185
(707) 565-8190
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
5765
NC
225XP0200X
Pediatric Occupational Therapist
Primary
5905
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7301830
—
NC
Enumeration date
12/14/2006
Last updated
02/04/2011
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