Provider Demographics
NPI:1558667535
Name:BLACKSHEAR, TAMARA RENAE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:RENAE
Last Name:BLACKSHEAR
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 1:20304 85TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-3041
Mailing Address - Country:US
Mailing Address - Phone:253-271-7546
Mailing Address - Fax:
Practice Address - Street 1:20304 85TH AVENUE CT E
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-3041
Practice Address - Country:US
Practice Address - Phone:253-271-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60191826225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist