Provider Demographics
NPI:1588003446
Name:WILLINGHAM, TAMARA DEANNE (LAC, DIPL OM)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:DEANNE
Last Name:WILLINGHAM
Suffix:
Gender:F
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27068 OAKMEAD DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-2657
Mailing Address - Country:US
Mailing Address - Phone:419-345-4996
Mailing Address - Fax:
Practice Address - Street 1:27068 OAKMEAD DR
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-2657
Practice Address - Country:US
Practice Address - Phone:419-345-4996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000235171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist