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NPI Code Detail

MEDICARE: TAMMY RENEE ROBERTSON

MEDICARE: TAMMY RENEE ROBERTSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy Assistant4848NC

General Provider Information

NPI Number : 1326242223
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMMY RENEE ROBERTSON
Provider Business Mailing Address
First Line : 5B BUCKBOARD LN
Second Line :
City : GREENSBORO
State : NC
Zip : 27410
Country : US
Telephone Number : 336-345-8839
Fax Number :
Provider Business Practice Location Address
First Line : 206 GREENSBORO RD
Second Line :
City : HIGH POINT
State : NC
Zip : 27260-3456
Country : US
Telephone Number : 336-882-2164
Fax Number : 336-882-2164
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2007
Last Update Date : 07/08/2007

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