Provider Demographics
NPI:1568561322
Name:MANN, TAMRA CARLSON (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TAMRA
Middle Name:CARLSON
Last Name:MANN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:TAMRA
Other - Middle Name:CARLSON
Other - Last Name:SWOPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:873 DEERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-3241
Mailing Address - Country:US
Mailing Address - Phone:205-647-5527
Mailing Address - Fax:
Practice Address - Street 1:245 CAHABA VALLEY PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-2216
Practice Address - Country:US
Practice Address - Phone:205-942-6820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0115225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-30477OtherBLUE CROSS BLUE SHIELD PR