Provider Demographics
NPI:1679258644
Name:BECKENBAUGH, TAMARA M
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:M
Last Name:BECKENBAUGH
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 1:12 BLACK PINE DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-9186
Mailing Address - Country:US
Mailing Address - Phone:717-580-3868
Mailing Address - Fax:
Practice Address - Street 1:12 BLACK PINE DR
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-9186
Practice Address - Country:US
Practice Address - Phone:717-580-3868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA4120536252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency