Provider Demographics
NPI:1437422326
Name:SEYMOUR, TARA (LMT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1948
Mailing Address - Street 2:266 W SISTERS VIEW
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759-1948
Mailing Address - Country:US
Mailing Address - Phone:541-420-2400
Mailing Address - Fax:
Practice Address - Street 1:2065 NE WILLIAMSON CT
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3867
Practice Address - Country:US
Practice Address - Phone:541-133-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6276174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist