Provider Demographics
NPI:1194187476
Name:PAUL, TAMMI
Entity Type:Individual
Prefix:
First Name:TAMMI
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28399 VALLEY VIEW RD
Mailing Address - Street 2:
Mailing Address - City:SHEDD
Mailing Address - State:OR
Mailing Address - Zip Code:97377-9761
Mailing Address - Country:US
Mailing Address - Phone:541-912-4009
Mailing Address - Fax:
Practice Address - Street 1:1300 BROADWAY ST NE STE 403
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1420
Practice Address - Country:US
Practice Address - Phone:541-912-4009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW0408175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist