Provider Demographics
NPI:1205843406
Name:SMICK, TAMI LYNETTE (MBA, PT)
Entity type:Individual
Prefix:MS
First Name:TAMI
Middle Name:LYNETTE
Last Name:SMICK
Suffix:
Gender:F
Credentials:MBA, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9220 SE TOLBERT ST
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9634
Mailing Address - Country:US
Mailing Address - Phone:503-730-1204
Mailing Address - Fax:
Practice Address - Street 1:9220 SE TOLBERT ST
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9634
Practice Address - Country:US
Practice Address - Phone:503-730-1204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPT1520208100000X
WAPT60157690208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation