Provider Demographics
NPI:1881494540
Name:ALLEN, TAMARA MICHELE
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:MICHELE
Last Name:ALLEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 S RELIC RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-8713
Mailing Address - Country:US
Mailing Address - Phone:435-680-7736
Mailing Address - Fax:
Practice Address - Street 1:242 N 200 W
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2710
Practice Address - Country:US
Practice Address - Phone:435-680-7736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10459099-4003225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist