Provider Demographics
NPI:1053543827
Name:TOVER, TANYA MARIE (LMT)
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:MARIE
Last Name:TOVER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 LAVONA DR NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-3743
Mailing Address - Country:US
Mailing Address - Phone:503-999-3577
Mailing Address - Fax:
Practice Address - Street 1:1880 LANCASTER DR NE STE 101
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1040
Practice Address - Country:US
Practice Address - Phone:503-362-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9693174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist