MEDICARE: TAMARA MICHELLE YOUNG O.T.R.

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	225X00000X	Occupational Therapist	109584	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	85065T	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1699896183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA MICHELLE YOUNG O.T.R.

Provider Business Mailing Address
First Line	:	533 RANCH TRL APT 161
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-7615
Country	:	US
Telephone Number	:	972-869-9575
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 GRAVEL DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76118-6950
Country	:	US
Telephone Number	:	817-589-7033
Fax Number	:	817-595-1178

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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