Provider Demographics
NPI:1316639180
Name:WEINSTEIN, TARA NICOLE (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:NICOLE
Last Name:WEINSTEIN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 BELLE POINT DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8274
Mailing Address - Country:US
Mailing Address - Phone:703-731-1329
Mailing Address - Fax:
Practice Address - Street 1:500 FOREST CIR
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2870
Practice Address - Country:US
Practice Address - Phone:703-731-1329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6679225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist