Provider Demographics
NPI:1942704028
Name:HILL, TAMARA LOUISE
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LOUISE
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:LOUISE
Other - Last Name:GOLDSMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9901 S LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-1339
Mailing Address - Country:US
Mailing Address - Phone:773-931-6715
Mailing Address - Fax:
Practice Address - Street 1:142 E 154TH ST
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-3326
Practice Address - Country:US
Practice Address - Phone:773-931-6715
Practice Address - Fax:708-566-1786
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist