Individual
TARA FOX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MOT OTRL
Contact information
Practice address
156 SHADOW WOOD BND, ST SIMONS ISLAND, GA 31522-5713
(678) 333-5832
Mailing address
156 SHADOW WOOD BND, ST SIMONS ISLAND, GA 31522-5713
(678) 333-5832
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
OT 11705
FL
225XP0200X
Pediatric Occupational Therapist
Primary
OT004571
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
890417100
—
FL
Enumeration date
10/21/2005
Last updated
05/23/2012
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