Healthcare Provider Details

I. General information

NPI: 1376557876
Provider Name (Legal Business Name): TAMMY YEARY OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 PIN OAK DR
MORRISTOWN TN
37814-1432
US

IV. Provider business mailing address

885 RONALD DR
TALBOTT TN
37877-8342
US

V. Phone/Fax

Practice location:
  • Phone: 423-748-4800
  • Fax: 423-585-5889
Mailing address:
  • Phone: 423-748-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2767
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: