Provider Demographics
NPI:1427669472
Name:SMITH, TAMELA A (LMT, MMP)
Entity type:Individual
Prefix:
First Name:TAMELA
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:TAMELA
Other - Middle Name:A
Other - Last Name:ROLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT, MMP
Mailing Address - Street 1:7601 FM 1960 RD E # 307
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-2209
Mailing Address - Country:US
Mailing Address - Phone:832-439-3291
Mailing Address - Fax:
Practice Address - Street 1:7601 FM 1960 RD E # 307
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-2209
Practice Address - Country:US
Practice Address - Phone:832-439-3291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT109876225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist