Provider Demographics
NPI:1073780243
Name:WADE, TAMI BRIANNA (LMT 3708-146)
Entity Type:Individual
Prefix:MRS
First Name:TAMI
Middle Name:BRIANNA
Last Name:WADE
Suffix:
Gender:F
Credentials:LMT 3708-146
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 E GREEN BAY AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:SAUKVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53080-2039
Mailing Address - Country:US
Mailing Address - Phone:262-284-0022
Mailing Address - Fax:855-798-9891
Practice Address - Street 1:620 E GREEN BAY AVE STE 104
Practice Address - Street 2:
Practice Address - City:SAUKVILLE
Practice Address - State:WI
Practice Address - Zip Code:53080-2039
Practice Address - Country:US
Practice Address - Phone:262-284-0022
Practice Address - Fax:855-798-9891
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3708-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist