Provider Demographics
NPI:1912496506
Name:DIMOND, TAMRA (COTA/L, CLT)
Entity type:Individual
Prefix:MRS
First Name:TAMRA
Middle Name:
Last Name:DIMOND
Suffix:
Gender:F
Credentials:COTA/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 JOSHUA WAY
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-8953
Mailing Address - Country:US
Mailing Address - Phone:208-539-1282
Mailing Address - Fax:
Practice Address - Street 1:840 ADDISON AVE
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5203
Practice Address - Country:US
Practice Address - Phone:208-595-4941
Practice Address - Fax:208-595-4931
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOTA-1643224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant