Provider Demographics
NPI:1558654905
Name:EARLY, TAMARA LEANN (LPN)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LEANN
Last Name:EARLY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 WOODINGHAM PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-5401
Mailing Address - Country:US
Mailing Address - Phone:614-271-3897
Mailing Address - Fax:
Practice Address - Street 1:557 WOODINGHAM PL
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-5401
Practice Address - Country:US
Practice Address - Phone:614-271-3897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH385HR2060X-RESPITE C385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child