Provider Demographics
NPI:1275740904
Name:STRIKE-NELSON, TAMARA JILL (OTR,L)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:JILL
Last Name:STRIKE-NELSON
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 1:105 PHYSICIANS PARK DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-7551
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22971 HIGHWAY 76 E
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-7529
Practice Address - Country:US
Practice Address - Phone:864-938-0111
Practice Address - Fax:864-938-0811
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1843225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH0753Medicaid
SCGP2785Medicaid
SCQ333564272Medicare ID - Type UnspecifiedMEDICARE NUMBER
SCGP2785Medicaid