Provider Demographics
NPI:1902211980
Name:LOBDELL, TAMARA (LMT)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:LOBDELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 874
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-0874
Mailing Address - Country:US
Mailing Address - Phone:541-289-9966
Mailing Address - Fax:541-289-9976
Practice Address - Street 1:1155 W LINDA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-9601
Practice Address - Country:US
Practice Address - Phone:541-289-9966
Practice Address - Fax:541-289-9976
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10666225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist