Individual
MRS. TAMARA PRUETTE HEACOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
3200 CONCORD RD, ASTON, PA 19014-1931
(610) 859-7833
Mailing address
509 MONTANA AVE, ALDAN, PA 19018-3216
(610) 623-1343
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
OC003910L
PA
Other
Enumeration date
10/24/2012
Last updated
10/24/2012
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