Provider Demographics
NPI:1164682753
Name:OBE, TAMMY LEA (PTA COTA L)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:LEA
Last Name:OBE
Suffix:
Gender:F
Credentials:PTA COTA L
Other - Prefix:MISS
Other - First Name:TAMMY
Other - Middle Name:LEA
Other - Last Name:HOLBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 NORTH WATER STREET
Mailing Address - Street 2:
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818
Mailing Address - Country:US
Mailing Address - Phone:608-348-2453
Mailing Address - Fax:608-348-2944
Practice Address - Street 1:1300 NORTH WATER STREET
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818
Practice Address - Country:US
Practice Address - Phone:608-348-2453
Practice Address - Fax:608-348-2944
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2017027224Z00000X
WI1355019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant