Provider Demographics
NPI:1750811303
Name:KHILLA, TAMARA (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:
Last Name:KHILLA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43860 10TH ST WEST
Mailing Address - Street 2:
Mailing Address - City:LANCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534
Mailing Address - Country:US
Mailing Address - Phone:661-945-7878
Mailing Address - Fax:661-945-7553
Practice Address - Street 1:43860 10TH ST WEST
Practice Address - Street 2:
Practice Address - City:LANCHESTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-945-7878
Practice Address - Fax:661-945-7553
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA3800224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant