Provider Demographics
NPI:1184920258
Name:PURDIE, TAMIKO LACHUM
Entity type:Individual
Prefix:
First Name:TAMIKO
Middle Name:LACHUM
Last Name:PURDIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMIKO
Other - Middle Name:LACHUM
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:977 SANDPOINT POND LN
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-0947
Mailing Address - Country:US
Mailing Address - Phone:702-234-3141
Mailing Address - Fax:
Practice Address - Street 1:7381 PRAIRIE FALCON RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0811
Practice Address - Country:US
Practice Address - Phone:702-646-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst