Healthcare Provider Details

I. General information

NPI: 1689320533
Provider Name (Legal Business Name): TAMARA KESTER CREAM MOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9247 N MERIDIAN ST STE 206
INDIANAPOLIS IN
46260-1824
US

IV. Provider business mailing address

9247 N MERIDIAN ST STE 206
INDIANAPOLIS IN
46260-1824
US

V. Phone/Fax

Practice location:
  • Phone: 317-504-7503
  • Fax: 317-795-0949
Mailing address:
  • Phone: 317-504-7503
  • Fax: 317-795-0949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: