Provider Demographics
NPI:1194782102
Name:MECHAELSEN, TAMARA JO (PT)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:JO
Last Name:MECHAELSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:JO
Other - Last Name:GROEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:510 BANK ST
Practice Address - Street 2:
Practice Address - City:WEBSTER CITY
Practice Address - State:IA
Practice Address - Zip Code:50595-2204
Practice Address - Country:US
Practice Address - Phone:515-832-8484
Practice Address - Fax:515-832-5401
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01489225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist