Provider Demographics
NPI:1154967735
Name:MITCHELL, TAMARA DICKINSON (OTR/L)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:DICKINSON
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:TAMI
Other - Middle Name:SUE
Other - Last Name:DICKINSON MITCHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2100 OUTLET CENTER DR STE 380
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0627
Mailing Address - Country:US
Mailing Address - Phone:805-385-4180
Mailing Address - Fax:
Practice Address - Street 1:2100 OUTLET CENTER DR STE 380
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0627
Practice Address - Country:US
Practice Address - Phone:805-385-4180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1166225XF0002X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing