Individual
MRS. TARA A SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR L
Contact information
Practice address
1000 EDDY STREET, PROVIDENCE, RI 02905
(401) 533-9100
Mailing address
1000 EDDY STREET, PROVIDENCE, RI 02905
(401) 533-9100
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT00837
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2058
SS NHPRC
RI
01
—
409462
SS BCHIP
RI
01
—
6400144
SS UHP
RI
01
—
99947
SS BCROSS
RI
Enumeration date
06/29/2006
Last updated
01/20/2011
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