Provider Demographics
NPI:1659486454
Name:TAM, PATTY
Entity Type:Individual
Prefix:
First Name:PATTY
Middle Name:
Last Name:TAM
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 1:1 CYMBIDIUM CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-2266
Mailing Address - Country:US
Mailing Address - Phone:650-589-9020
Mailing Address - Fax:
Practice Address - Street 1:125 SHOREWAY RD
Practice Address - Street 2:STE 1500
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-2788
Practice Address - Country:US
Practice Address - Phone:650-591-9581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3341OtherLICENSE #