MEDICARE: MRS. TAMMY LYNN COLON MSOTR/L

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
1	174400000X	Specialist	KY-R3839	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000972248	OTHER	KY	ANTHEM BCBS
2	236445	OTHER		NATIONAL BOARD FOR CERTIFICATION N OCCUPATIONAL THERAPY INC..
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	132092	OTHER	KY	LICENSE
5	31004543A	OTHER	IN	INDIANA PROFESSIONAL LICENSING AGENCY FOR OCCUPATIONAL THERAPY

General Provider Information

NPI Number	:	1427212356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMMY LYNN COLON MSOTR/L

Provider Business Mailing Address
First Line	:	PO BOX 3276
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47731-3276
Country	:	US
Telephone Number	:	812-473-0181
Fax Number	:	812-473-5822

Provider Business Practice Location Address
First Line	:	1169 EASTERN PKWY
Second Line	:	SUITE 2313
City	:	LOUISVILLE
State	:	KY
Zip	:	40217-1417
Country	:	US
Telephone Number	:	502-309-9800
Fax Number	:	502-309-9797

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	09/16/2016

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