Provider Demographics
NPI:1033413737
Name:TWITCHELL, TAMORA S (AAS, RMT)
Entity Type:Individual
Prefix:
First Name:TAMORA
Middle Name:S
Last Name:TWITCHELL
Suffix:
Gender:F
Credentials:AAS, RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9821 BUCKNELL CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-4394
Mailing Address - Country:US
Mailing Address - Phone:303-791-8017
Mailing Address - Fax:
Practice Address - Street 1:9821 BUCKNELL CT
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-4394
Practice Address - Country:US
Practice Address - Phone:303-791-8017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10295225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist