Provider Demographics
NPI:1043440001
Name:REESE, TAMILYNN (IDMT)
Entity Type:Individual
Prefix:MS
First Name:TAMILYNN
Middle Name:
Last Name:REESE
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:BARNEGAT
Mailing Address - State:NJ
Mailing Address - Zip Code:08005-1671
Mailing Address - Country:US
Mailing Address - Phone:314-556-4755
Mailing Address - Fax:
Practice Address - Street 1:54 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:BARNEGAT
Practice Address - State:NJ
Practice Address - Zip Code:08005-1671
Practice Address - Country:US
Practice Address - Phone:314-556-4755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians