Provider Demographics
NPI:1366633372
Name:SHEARER, TAMARA L (OTR/L)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:SHEARER
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 1:2831 SE PALMQUIST RD
Mailing Address - Street 2:APT. F224
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-5271
Mailing Address - Country:US
Mailing Address - Phone:503-761-3181
Mailing Address - Fax:
Practice Address - Street 1:5601 SE 122ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-4601
Practice Address - Country:US
Practice Address - Phone:503-761-3181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR227185225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist