Provider Demographics
NPI:1669745055
Name:RYAN, TAMARA LYNN
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:LYNN
Last Name:RYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 SHORE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OCEAN VIEW
Mailing Address - State:NJ
Mailing Address - Zip Code:08230-1379
Mailing Address - Country:US
Mailing Address - Phone:609-486-6379
Mailing Address - Fax:
Practice Address - Street 1:1217 SHORE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:OCEAN VIEW
Practice Address - State:NJ
Practice Address - Zip Code:08230-1379
Practice Address - Country:US
Practice Address - Phone:609-486-6379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist