Provider Demographics
NPI:1265046213
Name:MORRIS, TAMARA MARIE (COTA)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:MARIE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:TAMARA
Other - Middle Name:MARIE
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1211 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:MENDOTA
Mailing Address - State:IL
Mailing Address - Zip Code:61342-1534
Mailing Address - Country:US
Mailing Address - Phone:815-761-9318
Mailing Address - Fax:
Practice Address - Street 1:1201 1ST AVE
Practice Address - Street 2:
Practice Address - City:MENDOTA
Practice Address - State:IL
Practice Address - Zip Code:61342-1815
Practice Address - Country:US
Practice Address - Phone:800-397-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-06
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.000352224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty