Provider Demographics
NPI:1497198527
Name:HOPKINS, TAMMY ANN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:ANN
Last Name:HOPKINS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MRS
Other - First Name:TAMMY
Other - Middle Name:ANN
Other - Last Name:QUALLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11806 BINNEY RD
Mailing Address - Street 2:
Mailing Address - City:NEW DOUGLAS
Mailing Address - State:IL
Mailing Address - Zip Code:62074-1054
Mailing Address - Country:US
Mailing Address - Phone:618-781-9856
Mailing Address - Fax:
Practice Address - Street 1:11806 BINNEY RD
Practice Address - Street 2:
Practice Address - City:NEW DOUGLAS
Practice Address - State:IL
Practice Address - Zip Code:62074-1054
Practice Address - Country:US
Practice Address - Phone:618-781-9856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057003756224Z00000X
MO2013008794224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant