Provider Demographics
NPI:1174885933
Name:STEVENSON, TAMARA LYNN (CMT)
Entity type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:LYNN
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 S BLACKHAWK WAY APT D
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-6901
Mailing Address - Country:US
Mailing Address - Phone:720-422-7335
Mailing Address - Fax:
Practice Address - Street 1:2050 S ONEIDA ST STE 200C
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-2426
Practice Address - Country:US
Practice Address - Phone:720-291-1938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8498225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist