Provider Demographics
NPI:1558798678
Name:DICKESON, TAMARA POTTER (LMT)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:POTTER
Last Name:DICKESON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 E SKELLY DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6062
Mailing Address - Country:US
Mailing Address - Phone:918-720-3864
Mailing Address - Fax:918-933-5246
Practice Address - Street 1:2251 E SKELLY DR
Practice Address - Street 2:SUITE 103
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6062
Practice Address - Country:US
Practice Address - Phone:918-720-3864
Practice Address - Fax:918-933-5246
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist