Basic Information
| Provider Information | |||||||||
| NPI: | 1366785057 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TABOR | ||||||||
| FirstName: | MELISSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 974 | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109240974 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456151585 | ||||||||
| FaxNumber: | 8456151576 | ||||||||
| Practice Location | |||||||||
| Address1: | 2520 REGENCY RD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405032921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592240834 | ||||||||
| FaxNumber: | 8592240882 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2013 | ||||||||
| LastUpdateDate: | 07/08/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | R5472 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.