Provider Demographics
NPI:1003823485
Name:MILLS, TAMARA LOUTRICIA (PHD, OTR/L, ATP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LOUTRICIA
Last Name:MILLS
Suffix:
Gender:F
Credentials:PHD, OTR/L, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3346 WAGGONER PL
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273-5215
Mailing Address - Country:US
Mailing Address - Phone:678-592-9810
Mailing Address - Fax:678-565-9657
Practice Address - Street 1:3346 WAGGONER PL
Practice Address - Street 2:
Practice Address - City:REX
Practice Address - State:GA
Practice Address - Zip Code:30273-5215
Practice Address - Country:US
Practice Address - Phone:678-592-9810
Practice Address - Fax:678-565-9657
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225CA2400X
GAOT003050225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist