Provider Demographics
NPI:1881770170
Name:THOM, TAMARA MICHELLE (LMP)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:MICHELLE
Last Name:THOM
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27232 SE 13TH PL
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-5961
Mailing Address - Country:US
Mailing Address - Phone:425-313-8814
Mailing Address - Fax:
Practice Address - Street 1:2661 BEL RED RD
Practice Address - Street 2:SUITE 207
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-2200
Practice Address - Country:US
Practice Address - Phone:425-313-8814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022712174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA09299OtherFIRST CHOICE HEALTH