Provider Demographics
NPI:1427212356
Name:COLON, TAMMY LYNN (MSOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:LYNN
Last Name:COLON
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:LYNN
Other - Last Name:BROSHEARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOTR/L
Mailing Address - Street 1:PO BOX 3276
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47731-3276
Mailing Address - Country:US
Mailing Address - Phone:812-473-0181
Mailing Address - Fax:812-473-5822
Practice Address - Street 1:1169 EASTERN PKWY
Practice Address - Street 2:SUITE 2313
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1417
Practice Address - Country:US
Practice Address - Phone:502-309-9800
Practice Address - Fax:502-309-9797
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R3839174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000972248OtherANTHEM BCBS
236445OtherNATIONAL BOARD FOR CERTIFICATION N OCCUPATIONAL THERAPY INC..
KY7100369700Medicaid
KY132092OtherLICENSE
IN31004543AOtherINDIANA PROFESSIONAL LICENSING AGENCY FOR OCCUPATIONAL THERAPY
KYK137240Medicare PIN