Provider Demographics
NPI:1871221184
Name:TRIGG, TARA B (MS)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:B
Last Name:TRIGG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 LINCOLN ST # D
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-2855
Mailing Address - Country:US
Mailing Address - Phone:860-748-6691
Mailing Address - Fax:
Practice Address - Street 1:64 LINCOLN ST # D
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-2855
Practice Address - Country:US
Practice Address - Phone:860-748-6691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-13
Last Update Date:2022-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT203871374700000X
224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
No374700000XNursing Service Related ProvidersTechnician