Provider Demographics
NPI:1629545314
Name:SALAZAR, TAMARA MICHELLE
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:MICHELLE
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 SUMMERDALE AVE NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-3166
Mailing Address - Country:US
Mailing Address - Phone:330-880-6048
Mailing Address - Fax:
Practice Address - Street 1:1033 SUMMERDALE AVE NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-3166
Practice Address - Country:US
Practice Address - Phone:330-880-6048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator