Provider Demographics
NPI:1134462575
Name:EVEN, TAMARA LYNN (COTA)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LYNN
Last Name:EVEN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 164TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:BARNEY
Mailing Address - State:ND
Mailing Address - Zip Code:58008-9640
Mailing Address - Country:US
Mailing Address - Phone:406-670-5047
Mailing Address - Fax:
Practice Address - Street 1:2237 N 36TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-3001
Practice Address - Country:US
Practice Address - Phone:888-873-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT473224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant