Provider Demographics
NPI:1275096075
Name:TERRILL, TAMBERLENE HAYES (RN, BSN, LMT, MMP)
Entity Type:Individual
Prefix:
First Name:TAMBERLENE
Middle Name:HAYES
Last Name:TERRILL
Suffix:
Gender:F
Credentials:RN, BSN, LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10916 STEVENS LN
Mailing Address - Street 2:
Mailing Address - City:MECOSTA
Mailing Address - State:MI
Mailing Address - Zip Code:49332-9504
Mailing Address - Country:US
Mailing Address - Phone:517-819-5862
Mailing Address - Fax:
Practice Address - Street 1:9930 11 MILE RD
Practice Address - Street 2:
Practice Address - City:MECOSTA
Practice Address - State:MI
Practice Address - Zip Code:49332-9743
Practice Address - Country:US
Practice Address - Phone:989-857-9042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2019-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501010978225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty