Provider Demographics
NPI:1407359961
Name:PHELPS, TAMIKA LA CHER
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:LA CHER
Last Name:PHELPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 MARY BETH BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-9625
Mailing Address - Country:US
Mailing Address - Phone:301-996-2656
Mailing Address - Fax:
Practice Address - Street 1:4615 MARY BETH BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-9625
Practice Address - Country:US
Practice Address - Phone:301-996-2656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1117191744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management