Provider Demographics
NPI:1821189069
Name:SEABROOK, TAMARA
Entity Type:Individual
Prefix:MISS
First Name:TAMARA
Middle Name:
Last Name:SEABROOK
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:USAMEDDAC WUERZBERG
Mailing Address - Street 2:ATTN:CREDENTIALS OFFICE UNIT 26610
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09244
Mailing Address - Country:DE
Mailing Address - Phone:01149931-804-3616
Mailing Address - Fax:01149931-804-3241
Practice Address - Street 1:USAMEDDAC WUERZBURG EDIS-ANSBACH
Practice Address - Street 2:235TH BSB UNIT 28614
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09177
Practice Address - Country:DE
Practice Address - Phone:0114998-118-3811
Practice Address - Fax:0114998-118-3854
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6076235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN