Provider Demographics
NPI:1104077700
Name:LETINA, TAMARA SUE
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:SUE
Last Name:LETINA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TAMARA
Other - Middle Name:SUE
Other - Last Name:DOTEGOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13963 S HOFFMAN RD
Mailing Address - Street 2:APT #1
Mailing Address - City:SPRINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14141-9770
Mailing Address - Country:US
Mailing Address - Phone:716-262-6181
Mailing Address - Fax:
Practice Address - Street 1:10714 NORTH RD
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:NY
Practice Address - Zip Code:14129-9746
Practice Address - Country:US
Practice Address - Phone:716-532-1049
Practice Address - Fax:716-532-0679
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14792-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist