Individual
TAMARA THEODORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., O.T.R./L
Contact information
Practice address
1176 TIGER LILY LN, LINCOLN, CA 95648-8122
(916) 434-7117
Mailing address
1176 TIGER LILY LN, LINCOLN, CA 95648-8122
(916) 434-7117
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
3240
CA
Other
Enumeration date
10/25/2010
Last updated
10/25/2010
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