Provider Demographics
NPI:1134396054
Name:KING, TAMER THERESA (HIS)
Entity type:Individual
Prefix:
First Name:TAMER
Middle Name:THERESA
Last Name:KING
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E BROADWAY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-4127
Mailing Address - Country:US
Mailing Address - Phone:580-233-0321
Mailing Address - Fax:
Practice Address - Street 1:114 E BROADWAY AVE STE B
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-4127
Practice Address - Country:US
Practice Address - Phone:580-233-0321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1015237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist