Healthcare Provider Details

I. General information

NPI: 1841359494
Provider Name (Legal Business Name): TAMARA L NORMAN M.S., OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1732 W SYCAMORE ST
KOKOMO IN
46901-4227
US

IV. Provider business mailing address

1732 W SYCAMORE ST
KOKOMO IN
46901-4227
US

V. Phone/Fax

Practice location:
  • Phone: 765-457-1708
  • Fax: 765-457-5305
Mailing address:
  • Phone: 765-457-1708
  • Fax: 765-457-5305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number31003417A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: