Provider Demographics
NPI:1427078252
Name:STOUT, TAMELA ULILA (ATC)
Entity type:Individual
Prefix:MS
First Name:TAMELA
Middle Name:ULILA
Last Name:STOUT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 DOUBLE TREE RD
Mailing Address - Street 2:
Mailing Address - City:ROZET
Mailing Address - State:WY
Mailing Address - Zip Code:82727-8471
Mailing Address - Country:US
Mailing Address - Phone:308-778-6518
Mailing Address - Fax:
Practice Address - Street 1:1103 E BOXELDER RD STE U
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5582
Practice Address - Country:US
Practice Address - Phone:307-686-8177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE442255A2300X
WY1492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty