Provider Demographics
NPI:1932822848
Name:BIRKEBAK, TAMBRA KAY
Entity Type:Individual
Prefix:
First Name:TAMBRA
Middle Name:KAY
Last Name:BIRKEBAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22732 10TH AVE S
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-6917
Mailing Address - Country:US
Mailing Address - Phone:206-861-2696
Mailing Address - Fax:
Practice Address - Street 1:12033 SE 256TH ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-6503
Practice Address - Country:US
Practice Address - Phone:253-373-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00001653225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist