Provider Demographics
NPI:1881851319
Name:RUSSELL, TAMRA CLAY (COTA)
Entity Type:Individual
Prefix:MS
First Name:TAMRA
Middle Name:CLAY
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4370 CELIA CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-9777
Mailing Address - Country:US
Mailing Address - Phone:828-754-8517
Mailing Address - Fax:828-439-9744
Practice Address - Street 1:107 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4505
Practice Address - Country:US
Practice Address - Phone:828-437-8760
Practice Address - Fax:828-439-9744
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0510224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant