Healthcare Provider Details

I. General information

NPI: 1821189069
Provider Name (Legal Business Name): MISS TAMARA SEABROOK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USAMEDDAC WUERZBURG EDIS-ANSBACH 235TH BSB UNIT 28614
APO AE
09177
DE

IV. Provider business mailing address

USAMEDDAC WUERZBERG ATTN:CREDENTIALS OFFICE UNIT 26610
APO AE
09244
DE

V. Phone/Fax

Practice location:
  • Phone: 01149981183811
  • Fax: 01149981183854
Mailing address:
  • Phone: 011499318043616
  • Fax: 011499318043241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA6076
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: