Provider Demographics
NPI:1003280256
Name:MANDER, TANYA RENEE (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:RENEE
Last Name:MANDER
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:MS
Other - First Name:TANYA
Other - Middle Name:RENEE
Other - Last Name:WILLEMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2261 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-3603
Mailing Address - Country:US
Mailing Address - Phone:877-496-3332
Mailing Address - Fax:
Practice Address - Street 1:2261 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-3603
Practice Address - Country:US
Practice Address - Phone:719-589-5851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-25
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0004491225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COOT.0004491OtherCO DORA
348812OtherNATIONAL BOARD CERTIFICATION IN OCCUPATIONAL THERAPY (NBCOT)