Healthcare Provider Details

I. General information

NPI: 1891387213
Provider Name (Legal Business Name): TAMMI RENEE PALMER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20926 SE 29TH ST STE C
HARRAH OK
73045-6610
US

IV. Provider business mailing address

PO BOX 3675
SHAWNEE OK
74802-3675
US

V. Phone/Fax

Practice location:
  • Phone: 405-391-2300
  • Fax:
Mailing address:
  • Phone: 405-214-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number685
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: