Provider Demographics
NPI:1922464759
Name:NORRIS, TAMARA S (MSOM LAC)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:S
Last Name:NORRIS
Suffix:
Gender:F
Credentials:MSOM LAC
Other - Prefix:MRS
Other - First Name:TAMARA
Other - Middle Name:S
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSOM LAC
Mailing Address - Street 1:1712 ZYDECO DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7216
Mailing Address - Country:US
Mailing Address - Phone:512-773-4209
Mailing Address - Fax:
Practice Address - Street 1:2911 A W GRIMES BLVD STE 720
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-4832
Practice Address - Country:US
Practice Address - Phone:512-773-4208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-09
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00988171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty