Provider Demographics
NPI:1124643051
Name:RIKE, TAMARA
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:RIKE
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 1:1107 S BEELINE HWY STE 3
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-5903
Mailing Address - Country:US
Mailing Address - Phone:928-474-5158
Mailing Address - Fax:
Practice Address - Street 1:1107 S BEELINE HWY STE 3
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5903
Practice Address - Country:US
Practice Address - Phone:928-474-5158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6827237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist