Provider Demographics
NPI:1275655243
Name:BATES, TAMRA LEE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:TAMRA
Middle Name:LEE
Last Name:BATES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 OLD SPRINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03603-4545
Mailing Address - Country:US
Mailing Address - Phone:603-826-3990
Mailing Address - Fax:
Practice Address - Street 1:5 NURSING HOME DR
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-7344
Practice Address - Country:US
Practice Address - Phone:603-542-9511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0729225200000X
VT041-0000487225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant