Provider Demographics
NPI:1487690178
Name:LAIR, TAMARA JEAN (LMP)
Entity Type:Individual
Prefix:MISS
First Name:TAMARA
Middle Name:JEAN
Last Name:LAIR
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4713 NW DIVISION AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663
Mailing Address - Country:US
Mailing Address - Phone:360-936-1419
Mailing Address - Fax:
Practice Address - Street 1:6202 NE HWY 99
Practice Address - Street 2:STE 4
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665
Practice Address - Country:US
Practice Address - Phone:360-695-6055
Practice Address - Fax:360-735-7628
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA024201MA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist