Provider Demographics
NPI:1588285092
Name:KAMARA, ISATA MARIAM (PTA)
Entity type:Individual
Prefix:
First Name:ISATA
Middle Name:MARIAM
Last Name:KAMARA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 CHESAPEAKE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-2151
Mailing Address - Country:US
Mailing Address - Phone:614-226-1480
Mailing Address - Fax:
Practice Address - Street 1:717 NEIL AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1609
Practice Address - Country:US
Practice Address - Phone:614-228-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA011713208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation