Individual
TARA CARMICHAEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
9229 N DRAGONFLY LN, WALTONVILLE, IL 62894-2413
(618) 708-0902
Mailing address
9229 N DRAGONFLY LN, WALTONVILLE, IL 62894-2413
(618) 708-0902
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-594-0
HI
Other
Enumeration date
07/26/2021
Last updated
07/26/2021
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