Provider Demographics
NPI:1598489841
Name:GAW, TAMARA (MS, ATC, ESQ)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:GAW
Suffix:
Gender:F
Credentials:MS, ATC, ESQ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6218 GEORGIA AVE NW # 1045
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5125
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 GLENTANAR DR
Practice Address - Street 2:
Practice Address - City:MOODIESBURN
Practice Address - State:SCOTLAND
Practice Address - Zip Code:G690HY
Practice Address - Country:GB
Practice Address - Phone:202-599-0739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1297024002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer