Healthcare Provider Details

I. General information

NPI: 1033235759
Provider Name (Legal Business Name): KELLY TAMMAN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 SILVER LAKE BLVD
DOVER DE
19904-2410
US

IV. Provider business mailing address

29 ZUIDER ZEE CT
MIDDLETOWN DE
19709-9671
US

V. Phone/Fax

Practice location:
  • Phone: 302-734-5990
  • Fax:
Mailing address:
  • Phone: 302-838-2827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberJ2-0000532
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: