Provider Demographics
NPI:1831808617
Name:WAREHAM, TANYA J (COTA/L)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:J
Last Name:WAREHAM
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 1:293 MOUNT DR APT 1404
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37876-1826
Mailing Address - Country:US
Mailing Address - Phone:480-262-7664
Mailing Address - Fax:
Practice Address - Street 1:914 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:DANDRIDGE
Practice Address - State:TN
Practice Address - Zip Code:37725-4700
Practice Address - Country:US
Practice Address - Phone:865-397-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOTA0000003793224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant