Provider Demographics
NPI:1629741608
Name:CHANGELIAN, TAMAR GAYANE (BS, ATC)
Entity Type:Individual
Prefix:
First Name:TAMAR
Middle Name:GAYANE
Last Name:CHANGELIAN
Suffix:
Gender:F
Credentials:BS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:211 RANTOUL ST APT 302
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-4295
Mailing Address - Country:US
Mailing Address - Phone:248-444-6538
Mailing Address - Fax:
Practice Address - Street 1:215 S MAIN ST UNIT A
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:MA
Practice Address - Zip Code:01949-2440
Practice Address - Country:US
Practice Address - Phone:978-769-1102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer