Provider Demographics
NPI:1790399889
Name:NEDLEY, TAMARA S (COTA/L)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:S
Last Name:NEDLEY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8155 W THUNDERBIRD RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4159
Mailing Address - Country:US
Mailing Address - Phone:623-209-1000
Mailing Address - Fax:623-209-1001
Practice Address - Street 1:8155 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4159
Practice Address - Country:US
Practice Address - Phone:623-209-1000
Practice Address - Fax:623-209-1001
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005852225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist