Provider Demographics
NPI:1043429061
Name:HAMMON, TAMMIE JO (MS, ATC,CSCS)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:JO
Last Name:HAMMON
Suffix:
Gender:F
Credentials:MS, ATC,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 246
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-9725
Mailing Address - Country:US
Mailing Address - Phone:304-472-8791
Mailing Address - Fax:
Practice Address - Street 1:59 COLLEGE AVE # 1795
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2600
Practice Address - Country:US
Practice Address - Phone:304-473-8682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer