Provider Demographics
NPI:1194391722
Name:OSIBOTE, TAMARA S (CMC)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:S
Last Name:OSIBOTE
Suffix:
Gender:F
Credentials:CMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 MAIN STREET BOX 156
Mailing Address - Street 2:
Mailing Address - City:CHENANGO BRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:13745-0156
Mailing Address - Country:US
Mailing Address - Phone:607-283-5176
Mailing Address - Fax:
Practice Address - Street 1:136 E. SERVICE ROAD
Practice Address - Street 2:SUITE 301
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901
Practice Address - Country:US
Practice Address - Phone:607-283-5176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
C-3371171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
C-3371OtherNATIONAL ACADEMY OF CERTIFIED CARE MANAGERS