Provider Demographics
NPI:1225749682
Name:RASMUSSEN, TAMBRA FARLEY (OTR/L)
Entity Type:Individual
Prefix:
First Name:TAMBRA
Middle Name:FARLEY
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6496 W TIMBERBROOK RD
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-1426
Mailing Address - Country:US
Mailing Address - Phone:801-230-4312
Mailing Address - Fax:
Practice Address - Street 1:867 S 800 W
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-4505
Practice Address - Country:US
Practice Address - Phone:801-785-9019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11339441-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist