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General NPI Number Information
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NPI Number | 1699896183
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Entity Type | Individual
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Provider Name | TAMARA MICHELLE YOUNG O.T.R.
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Gender | Female
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2300 GRAVEL DR
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City | FORT WORTH
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State | TX
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Zip | 76118-6950
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Country | US
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Telephone | 817-589-7033
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Fax | 817-595-1178
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Provider Business Mailing Address
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Address Line | 533 RANCH TRL APT 161
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City | IRVING
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State | TX
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Zip | 75063-7615
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Country | US
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Telephone | 972-869-9575
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 109584
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License Number State | TX
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