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General NPI Number Information
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NPI Number | 1194391722
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Entity Type | Individual
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Provider Name | TAMARA S OSIBOTE CMC
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Gender | Female
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Dates
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Enumeration Date | 06/03/2021
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Last Update Date | 03/07/2022
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Provider Practice Location Address
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Address Line | 136 E. SERVICE ROAD SUITE 301
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City | BINGHAMTON
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State | NY
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Zip | 13901
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Country | US
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Telephone | 607-283-5176
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Fax |
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Provider Business Mailing Address
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Address Line | 511 MAIN STREET BOX 156
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City | CHENANGO BRIDGE
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State | NY
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Zip | 13745-0156
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Country | US
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Telephone | 607-283-5176
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Fax |
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | C-3371
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License Number State |
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