Provider Demographics
NPI:1790395465
Name:JOHNSON, TAMARA LASHAE (CTRS, MSHA)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LASHAE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CTRS, MSHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-707 IHO PL APT 1401
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-2525
Mailing Address - Country:US
Mailing Address - Phone:601-467-7705
Mailing Address - Fax:
Practice Address - Street 1:459 PATTERSON RD BLDG 110
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1522
Practice Address - Country:US
Practice Address - Phone:808-433-0217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS70520225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist