Provider Demographics
NPI:1689358517
Name:SIBLEY, TAMARA M
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:M
Last Name:SIBLEY
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:PO BOX 444
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OR
Mailing Address - Zip Code:97391-0444
Mailing Address - Country:US
Mailing Address - Phone:541-961-3608
Mailing Address - Fax:
Practice Address - Street 1:321 SE 3RD ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OR
Practice Address - Zip Code:97391-1613
Practice Address - Country:US
Practice Address - Phone:541-336-2254
Practice Address - Fax:541-336-1803
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician