Provider Demographics
NPI:1295870574
Name:PALLOTT, TAMARA SHAWN (OTRL)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:SHAWN
Last Name:PALLOTT
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MRS
Other - First Name:TAMI
Other - Middle Name:SHAWN
Other - Last Name:PALLOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1520 PARKMOOR AVE STE A0149
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2420
Mailing Address - Country:US
Mailing Address - Phone:408-241-9911
Mailing Address - Fax:408-241-7788
Practice Address - Street 1:1520 PARKMOOR AVE STE A0149
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2420
Practice Address - Country:US
Practice Address - Phone:408-241-9911
Practice Address - Fax:408-241-7788
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT5124225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist