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General NPI Number Information
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NPI Number | 1609157023
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Entity Type | Individual
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Provider Name | TAMMY MOLDENHAUER OT
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Gender | Female
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Dates
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Enumeration Date | 08/30/2011
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Last Update Date | 09/28/2011
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Provider Practice Location Address
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Address Line | 409 SHORE LINE DR
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City | WICHITA FALLS
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State | TX
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Zip | 76308-5711
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Country | US
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Telephone | 940-781-1765
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Fax | 817-977-5547
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Provider Business Mailing Address
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Address Line | 4301 HOSPITAL DR
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City | VERNON
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State | TX
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Zip | 76384-3135
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Country | US
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Telephone | 940-781-1765
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Fax | 817-977-5547
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 109583
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License Number State | TX
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