Provider Demographics
NPI:1437188588
Name:DUBOSE, TARYN H (OT, CHT, QMHP)
Entity type:Individual
Prefix:
First Name:TARYN
Middle Name:H
Last Name:DUBOSE
Suffix:
Gender:F
Credentials:OT, CHT, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 SE DAVIS AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1333
Mailing Address - Country:US
Mailing Address - Phone:541-797-3638
Mailing Address - Fax:
Practice Address - Street 1:223 SE DAVIS AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1333
Practice Address - Country:US
Practice Address - Phone:541-797-3638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003738225X00000X
OR1066420225XM0800X, 225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500642902Medicaid
OR500642902Medicaid