Provider Demographics
NPI:1720633100
Name:WILLS, TAMARA MICHELLE (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:MICHELLE
Last Name:WILLS
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11633 168TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-1729
Mailing Address - Country:US
Mailing Address - Phone:646-671-0905
Mailing Address - Fax:
Practice Address - Street 1:4241 201ST ST
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2550
Practice Address - Country:US
Practice Address - Phone:718-423-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022385225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist