MEDICARE: TAMARA T WOODSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1184106924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMARA T WOODSON

Provider Business Mailing Address
First Line	:	6725 RAYMOND AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63133-1417
Country	:	US
Telephone Number	:	314-305-5406
Fax Number	:

Provider Business Practice Location Address
First Line	:	6725 RAYMOND AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63133-1417
Country	:	US
Telephone Number	:	314-305-5406
Fax Number	:

Authorized Official
Title or Position	:	CNA
Name	:	TAMARA T WOODSON
Credential	:	CNA
Telephone Number	:	314-305-5406

Provider Enumeration Date	:	08/29/2018
Last Update Date	:	08/29/2018

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