Provider Demographics
NPI:1902691553
Name:CRAIN, TAMARA LEE
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:LEE
Last Name:CRAIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 W DEVRON ST
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-9008
Mailing Address - Country:US
Mailing Address - Phone:918-315-7849
Mailing Address - Fax:
Practice Address - Street 1:2111 W DEVRON ST
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-9008
Practice Address - Country:US
Practice Address - Phone:918-315-7849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist