Provider Demographics
NPI:1558505552
Name:OFSANIK, TAMMY S (SLP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:S
Last Name:OFSANIK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 GEORGE WILSON RD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-8613
Mailing Address - Country:US
Mailing Address - Phone:828-265-0309
Mailing Address - Fax:828-264-6490
Practice Address - Street 1:638 GEORGE WILSON RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-8613
Practice Address - Country:US
Practice Address - Phone:828-265-0309
Practice Address - Fax:828-264-6490
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5090235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist