Provider Demographics
NPI:1295002350
Name:ODIE-ROSADO, TAMARA (OT)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:
Last Name:ODIE-ROSADO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 HAMMOCK LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-6008
Mailing Address - Country:US
Mailing Address - Phone:214-317-9931
Mailing Address - Fax:
Practice Address - Street 1:2402 HAMMOCK LAKE DR
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-6008
Practice Address - Country:US
Practice Address - Phone:214-317-9931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112727225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist