Provider Demographics
NPI:1659548451
Name:GOVER, TAMARA L (MSOTR)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:GOVER
Suffix:
Gender:F
Credentials:MSOTR
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:L
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOTR
Mailing Address - Street 1:5455 LALISTA CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-6166
Mailing Address - Country:US
Mailing Address - Phone:317-509-5305
Mailing Address - Fax:317-509-5305
Practice Address - Street 1:7112 ZIONSVILLE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-2163
Practice Address - Country:US
Practice Address - Phone:317-329-1000
Practice Address - Fax:317-329-1001
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99032094A225X00000X
IN31004654A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist