Provider Demographics
NPI:1538253240
Name:FORD, TAMERA LYNN (OTR)
Entity type:Individual
Prefix:
First Name:TAMERA
Middle Name:LYNN
Last Name:FORD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:TAMERA
Other - Middle Name:LYNN
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1003 DIVISION ST STE 6B
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1657
Mailing Address - Country:US
Mailing Address - Phone:928-275-2201
Mailing Address - Fax:928-275-1814
Practice Address - Street 1:1003 DIVISION ST STE 6B
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1657
Practice Address - Country:US
Practice Address - Phone:928-275-2201
Practice Address - Fax:928-275-1814
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT5511225XH1200X
AZOTH-008259225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFV821ZMedicare PIN
CAFV821YMedicare UPIN