Provider Demographics
NPI:1508086612
Name:EPPERSON, TAMMY JO (PT)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:JO
Last Name:EPPERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 562
Mailing Address - Street 2:7631 NORTH YORK ST
Mailing Address - City:OKAY
Mailing Address - State:OK
Mailing Address - Zip Code:74446-0562
Mailing Address - Country:US
Mailing Address - Phone:918-682-0836
Mailing Address - Fax:918-687-4092
Practice Address - Street 1:3310 CHANDLER RD
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-4906
Practice Address - Country:US
Practice Address - Phone:918-686-0646
Practice Address - Fax:918-687-4092
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OKPT2524225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist