Provider Demographics
NPI:1598509481
Name:JOHNSON-SCHLAGEL, TAMARA M (OTD OTR/L)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:M
Last Name:JOHNSON-SCHLAGEL
Suffix:
Gender:F
Credentials:OTD OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6943 KEYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-5795
Mailing Address - Country:US
Mailing Address - Phone:307-631-0192
Mailing Address - Fax:
Practice Address - Street 1:1951 BLUEGRASS CIR
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-7355
Practice Address - Country:US
Practice Address - Phone:307-773-8533
Practice Address - Fax:307-635-7578
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOT0460225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist