Provider Demographics
NPI:1023382066
Name:STARODUBTSEVA, TAMARA V (LMT)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:V
Last Name:STARODUBTSEVA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3755 HARLOW RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-5372
Mailing Address - Country:US
Mailing Address - Phone:541-653-9337
Mailing Address - Fax:
Practice Address - Street 1:3755 HARLOW RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5372
Practice Address - Country:US
Practice Address - Phone:541-653-9337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18729225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist