Provider Demographics
NPI:1457744518
Name:ARELLANO, TAMI JEAN (LMT)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:JEAN
Last Name:ARELLANO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E NEBRASKA ST TRLR 2
Mailing Address - Street 2:
Mailing Address - City:MUSCODA
Mailing Address - State:WI
Mailing Address - Zip Code:53573-8920
Mailing Address - Country:US
Mailing Address - Phone:608-532-6001
Mailing Address - Fax:
Practice Address - Street 1:1400 W SEMINARY ST
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-2036
Practice Address - Country:US
Practice Address - Phone:608-532-6001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-13
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4003146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist