Provider Demographics
NPI:1093950883
Name:STONE, TAMARA LYN (LMP, LAMP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LYN
Last Name:STONE
Suffix:
Gender:F
Credentials:LMP, LAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-9524
Mailing Address - Country:US
Mailing Address - Phone:360-319-9852
Mailing Address - Fax:
Practice Address - Street 1:460 HILLTOP DRIVE
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284
Practice Address - Country:US
Practice Address - Phone:360-319-9852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025001225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist