Provider Demographics
NPI:1952692105
Name:MCGOVERN, TAMMARA L (LMP)
Entity Type:Individual
Prefix:
First Name:TAMMARA
Middle Name:L
Last Name:MCGOVERN
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 1:1212 N WASHINGTON ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2403
Mailing Address - Country:US
Mailing Address - Phone:509-951-7289
Mailing Address - Fax:
Practice Address - Street 1:1212 N WASHINGTON ST
Practice Address - Street 2:SUITE 114
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2403
Practice Address - Country:US
Practice Address - Phone:509-951-7289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60214532225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist