Provider Demographics
NPI:1922544782
Name:YAHAWAHDAH, TAMAR (LMP MA60533856)
Entity Type:Individual
Prefix:
First Name:TAMAR
Middle Name:
Last Name:YAHAWAHDAH
Suffix:
Gender:F
Credentials:LMP MA60533856
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4002 S M ST STE I
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-3800
Mailing Address - Country:US
Mailing Address - Phone:253-226-7783
Mailing Address - Fax:
Practice Address - Street 1:4002 S M ST STE I
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-3800
Practice Address - Country:US
Practice Address - Phone:253-226-7783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60533856225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist