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General NPI Number Information
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NPI Number | 1144569898
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Entity Type | Individual
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Provider Name | TAMAR ELIZABETH MCCALLUM MS, ATC, VATL
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Gender | Female
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Dates
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Enumeration Date | 01/31/2013
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Last Update Date | 08/25/2014
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Provider Practice Location Address
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Address Line | 7630 TELEGRAPH RD
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City | ALEXANDRIA
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State | VA
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Zip | 22315-3821
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Country | US
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Telephone | 703-924-7579
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Fax | 703-924-7436
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Provider Business Mailing Address
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Address Line | 8225 SPRINGWOOD MEADOW LN APT #102
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City | LORTON
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State | VA
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Zip | 22079-2764
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Country | US
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Telephone | 703-924-7579
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Fax | 703-924-7436
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0126000052
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License Number State | VA
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