Provider Demographics
NPI:1629574546
Name:ODA, TAMANIKA M (LMT)
Entity Type:Individual
Prefix:
First Name:TAMANIKA
Middle Name:M
Last Name:ODA
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:PO BOX 370343
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30037-0343
Mailing Address - Country:US
Mailing Address - Phone:404-855-1612
Mailing Address - Fax:
Practice Address - Street 1:3485 N DESERT DR STE 100
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-5724
Practice Address - Country:US
Practice Address - Phone:404-855-1612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist