Provider Demographics
NPI:1285114280
Name:GOULAMAN, TAMARA
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:GOULAMAN
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 1:2032 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-5225
Mailing Address - Country:US
Mailing Address - Phone:860-256-7067
Mailing Address - Fax:
Practice Address - Street 1:7001 N ROXBURY MILL RD
Practice Address - Street 2:
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22551-2441
Practice Address - Country:US
Practice Address - Phone:860-256-7067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-19
Last Update Date:2018-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant