Provider Demographics
NPI:1871902585
Name:CLAES, TAMARA (OTR)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:CLAES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5049 E BONNY BRUCE DR
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127-9619
Mailing Address - Country:US
Mailing Address - Phone:269-429-1887
Mailing Address - Fax:269-429-6129
Practice Address - Street 1:716 DELAWARE CT
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:MI
Practice Address - Zip Code:49065-9715
Practice Address - Country:US
Practice Address - Phone:269-624-5208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006785225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5201006785OtherSTATE OF MICHIGAN OCCUPATIONAL THERAPIST LICENSE