Provider Demographics
NPI:1760366520
Name:BEALE, TARA LEE
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LEE
Last Name:BEALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CRANBERRY KNOLL ST
Mailing Address - Street 2:
Mailing Address - City:PLYMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:02367-1311
Mailing Address - Country:US
Mailing Address - Phone:508-245-4036
Mailing Address - Fax:508-245-4036
Practice Address - Street 1:6 CRANBERRY KNOLL ST
Practice Address - Street 2:
Practice Address - City:PLYMPTON
Practice Address - State:MA
Practice Address - Zip Code:02367-1311
Practice Address - Country:US
Practice Address - Phone:508-245-4036
Practice Address - Fax:508-245-4036
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA305YZG48H3335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier