Provider Demographics
NPI:1871454017
Name:WARD, TAMALYNN MARIE
Entity type:Individual
Prefix:
First Name:TAMALYNN
Middle Name:MARIE
Last Name:WARD
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 1:201 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MARINE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48039-3627
Mailing Address - Country:US
Mailing Address - Phone:810-765-9076
Mailing Address - Fax:
Practice Address - Street 1:201 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MARINE CITY
Practice Address - State:MI
Practice Address - Zip Code:48039-3627
Practice Address - Country:US
Practice Address - Phone:810-765-9076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-18
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501007461225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty