Provider Demographics
NPI:1457301947
Name:SLANKARD, TAMARA MARIE (OT)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:MARIE
Last Name:SLANKARD
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 1:5569 N SUGAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-4047
Mailing Address - Country:US
Mailing Address - Phone:618-395-6041
Mailing Address - Fax:618-395-6289
Practice Address - Street 1:800 E LOCUST ST
Practice Address - Street 2:RICHLAND MEMORIAL HOSPITAL
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-2553
Practice Address - Country:US
Practice Address - Phone:618-395-6041
Practice Address - Fax:618-395-6289
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-003204225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist