Provider Demographics
NPI:1295123560
Name:CALDWELL, TAMRA
Entity type:Individual
Prefix:
First Name:TAMRA
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1432
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97709-1432
Mailing Address - Country:US
Mailing Address - Phone:541-241-0744
Mailing Address - Fax:
Practice Address - Street 1:19800 VILLAGE OFFICE CT
Practice Address - Street 2:104
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1872
Practice Address - Country:US
Practice Address - Phone:541-241-0744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-IN-10173303106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician