Provider Demographics
NPI:1518187285
Name:WALSH, TAMARA G (LMP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:G
Last Name:WALSH
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 1:8811 OLD HIGHWAY 99 SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-5743
Mailing Address - Country:US
Mailing Address - Phone:360-888-8884
Mailing Address - Fax:
Practice Address - Street 1:4324 MARTIN WAY E STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98516-5367
Practice Address - Country:US
Practice Address - Phone:360-923-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019449174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist