Provider Demographics
NPI:1164113395
Name:MORIARTY, TAMMY L (LMT)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-2512
Mailing Address - Country:US
Mailing Address - Phone:860-965-1843
Mailing Address - Fax:
Practice Address - Street 1:200 SILVER ST
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-3065
Practice Address - Country:US
Practice Address - Phone:413-612-4360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17569225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA17569OtherCOMMONWEALTH OF MASSACHUSETTS DIVISION OF OCCUPATIONAL LICENSURE