Provider Demographics
NPI:1174847982
Name:BECKER, TARA (OT)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:HEINECKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:128 E OLIN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-1467
Mailing Address - Country:US
Mailing Address - Phone:608-252-1320
Mailing Address - Fax:608-252-1333
Practice Address - Street 1:128 E OLIN AVE STE 100
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-1467
Practice Address - Country:US
Practice Address - Phone:608-252-1320
Practice Address - Fax:608-252-1333
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4848-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist