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General NPI Number Information
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NPI Number | 1477947588
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Entity Type | Individual
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Provider Name | TAMMY VO-MOTA PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/26/2015
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Last Update Date | 03/26/2015
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Provider Practice Location Address
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Address Line | 2275 W JEFFERSON AVE
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City | TRENTON
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State | MI
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Zip | 48183-2114
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Country | US
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Telephone | 734-675-7210
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Fax |
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Provider Business Mailing Address
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Address Line | 13112 GOLF LAKE DR
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City | TAYLOR
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State | MI
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Zip | 48180-7960
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Country | US
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Telephone |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5601007321
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License Number State | MI
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