Provider Demographics
NPI:1053494732
Name:ROSEMYER, TAMARA LOUISE
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LOUISE
Last Name:ROSEMYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CHESTNUT STREET
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662
Mailing Address - Country:US
Mailing Address - Phone:315-769-8250
Mailing Address - Fax:
Practice Address - Street 1:1942 OLD DEKALB ROAD
Practice Address - Street 2:ST LAWRENCE NYSARC ARTICLE 28 CLINIC
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617
Practice Address - Country:US
Practice Address - Phone:315-386-2647
Practice Address - Fax:315-386-4071
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0105941235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist