Provider Demographics
NPI:1831226513
Name:TAMS, AMANDA L (ATC)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:L
Last Name:TAMS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81590 HIGHWAY 3 S
Mailing Address - Street 2:
Mailing Address - City:ST MARIES
Mailing Address - State:ID
Mailing Address - Zip Code:83861-7138
Mailing Address - Country:US
Mailing Address - Phone:208-582-0824
Mailing Address - Fax:
Practice Address - Street 1:81590 HIGHWAY 3 S
Practice Address - Street 2:
Practice Address - City:ST MARIES
Practice Address - State:ID
Practice Address - Zip Code:83861-7138
Practice Address - Country:US
Practice Address - Phone:208-582-0824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT-2302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer