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NPI Code Detail

MEDICARE: TAMMIE L BEGOTKA MOT, OTR/L

MEDICARE: TAMMIE L BEGOTKA MOT, OTR/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
1225X00000XOccupational Therapist4882-026WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14882-026OTHERWISTATE LICENSE

General Provider Information

NPI Number : 1568782076
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMMIE L BEGOTKA MOT, OTR/L
Provider Business Mailing Address
First Line : 30312 BEACHVIEW LN
Second Line :
City : WATERFORD
State : WI
Zip : 53185-3404
Country : US
Telephone Number : 708-699-8015
Fax Number :
Provider Business Practice Location Address
First Line : 3271 NORTH ST
Second Line :
City : EAST TROY
State : WI
Zip : 53120-1147
Country : US
Telephone Number : 262-684-5153
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2010
Last Update Date : 06/07/2010

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