Provider Demographics
NPI:1790219178
Name:HARMON, TAMARA ANN ROSE (MS)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:ANN ROSE
Last Name:HARMON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:TAMARA
Other - Middle Name:ANN
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1105 OLD FORGE DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1624
Mailing Address - Country:US
Mailing Address - Phone:706-429-7840
Mailing Address - Fax:
Practice Address - Street 1:1105 OLD FORGE DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1624
Practice Address - Country:US
Practice Address - Phone:706-429-7840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006402225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist