Provider Demographics
NPI:1336692482
Name:PAYNTER, TAMARA (COTA)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:PAYNTER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:
Other - Last Name:HOFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:15 NORTH E STREET
Mailing Address - Street 2:APARTMENT 38
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403
Mailing Address - Country:US
Mailing Address - Phone:360-561-0200
Mailing Address - Fax:
Practice Address - Street 1:15 NORTH E STREET
Practice Address - Street 2:APARTMENT 38
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403
Practice Address - Country:US
Practice Address - Phone:360-561-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC 60608607224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOC 60608607OtherCOTA LICENSE
WA352201OtherCERTIFIED OCCUPATIONAL THERAPY ASSISTANT COTA