Provider Demographics
NPI:1194022871
Name:MICHAELSON, TAMMY LYNN (HIS)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:MICHAELSON
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 GUERDAT RD
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-2836
Mailing Address - Country:US
Mailing Address - Phone:203-910-9645
Mailing Address - Fax:860-496-0423
Practice Address - Street 1:811 GUERDAT RD
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-2836
Practice Address - Country:US
Practice Address - Phone:203-910-9645
Practice Address - Fax:860-496-0423
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-16
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT410237700000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist