Provider Demographics
NPI:1477721389
Name:ERICKSON, TAMARA ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:ANN
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:TAMARA
Other - Middle Name:ANN
Other - Last Name:RICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1465 24TH ST
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:WI
Mailing Address - Zip Code:54082-2132
Mailing Address - Country:US
Mailing Address - Phone:715-549-5739
Mailing Address - Fax:
Practice Address - Street 1:301 RIVER ST
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:WI
Practice Address - Zip Code:54020-3024
Practice Address - Country:US
Practice Address - Phone:715-294-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5471-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist