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General NPI Number Information
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NPI Number | 1629574546
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Entity Type | Individual
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Provider Name | TAMANIKA M ODA LMT
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Gender | Female
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Dates
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Enumeration Date | 03/30/2018
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Last Update Date | 03/30/2018
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Provider Practice Location Address
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Address Line | 3485 N DESERT DR STE 100
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City | EAST POINT
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State | GA
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Zip | 30344-5724
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Country | US
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Telephone | 404-855-1612
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 370343
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City | DECATUR
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State | GA
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Zip | 30037-0343
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Country | US
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Telephone | 404-855-1612
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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 |
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License Number State | GA
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