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General NPI Number Information
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NPI Number | 1427626290
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Entity Type | Individual
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Provider Name | MRS. TAMARA MARIA PURNELL
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Gender | Female
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 06/16/2021
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Provider Practice Location Address
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Address Line | 12814 SHANK FARM WAY STE D
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City | HAGERSTOWN
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State | MD
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Zip | 21742-2949
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Country | US
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Telephone | 302-725-9084
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Fax |
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Provider Business Mailing Address
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Address Line | 12618 ROSENCRANS DR
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City | HAGERSTOWN
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State | MD
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Zip | 21740-1212
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Country | US
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Telephone | 302-725-9084
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT-0015118
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | R03340
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License Number State | MD
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