Provider Demographics
NPI:1710342001
Name:SURPRENANT, TAMARA ANN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:ANN
Last Name:SURPRENANT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9501 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MARCY
Mailing Address - State:NY
Mailing Address - Zip Code:13403-2074
Mailing Address - Country:US
Mailing Address - Phone:315-724-0683
Mailing Address - Fax:315-797-7527
Practice Address - Street 1:9501 RIVER RD
Practice Address - Street 2:
Practice Address - City:MARCY
Practice Address - State:NY
Practice Address - Zip Code:13403-2074
Practice Address - Country:US
Practice Address - Phone:315-724-0683
Practice Address - Fax:315-797-7527
Is Sole Proprietor?:No
Enumeration Date:2015-12-31
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004395-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist