| Doctor Name: | TARA SALLEE |
| NPI Number: | 1003107004 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LISW |
| License Number: | I. 1000287 |
| Business Practice Address: | 420 N James Rd Columbus, OH - 432191834 |
| Business Phone Number: | 6142575200 |
| Business Fax Number: | 6142575205 |
| Mailing Address: | 420 N James Rd, COLUMBUS |
| State: | OH |
| Postal Code: | 432191834 |
| Phone Number: | 6142575200 |
| Fax Number: | 6142575205 |
| NPI Enumeration Date: | 04/25/2011 |
| NPI Last Update Date: | 04/25/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QV0200X |
| License Number: | I. 1000287 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | VA |
| Taxonomy Definition: | |