Provider Demographics
NPI:1225075617
Name:DALE, TAMMY (OTR)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:DALE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 E KINGS DEER PT
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-2815
Mailing Address - Country:US
Mailing Address - Phone:719-640-2818
Mailing Address - Fax:
Practice Address - Street 1:495 E KINGS DEER PT
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-2815
Practice Address - Country:US
Practice Address - Phone:719-640-2818
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0289267225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics