Provider Demographics
NPI:1386391910
Name:OKERNS, TAMARA KAY
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:KAY
Last Name:OKERNS
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 1:75 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4381
Mailing Address - Country:US
Mailing Address - Phone:770-645-1900
Mailing Address - Fax:
Practice Address - Street 1:75 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4381
Practice Address - Country:US
Practice Address - Phone:770-645-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA000078224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant