Provider Demographics
NPI:1932445095
Name:NEWBERRY, TAMERA (CP, COA)
Entity Type:Individual
Prefix:
First Name:TAMERA
Middle Name:
Last Name:NEWBERRY
Suffix:
Gender:F
Credentials:CP, COA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5248 DARKMOOR LN
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-3036
Mailing Address - Country:US
Mailing Address - Phone:314-560-4060
Mailing Address - Fax:
Practice Address - Street 1:5248 DARKMOOR LN
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:MO
Practice Address - Zip Code:63052-3036
Practice Address - Country:US
Practice Address - Phone:314-560-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter