Provider Demographics
NPI:1568086189
Name:BELL, TAMMY LOU (PS2)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LOU
Last Name:BELL
Suffix:
Gender:F
Credentials:PS2
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:LOU
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 NE MLK BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2941
Mailing Address - Country:US
Mailing Address - Phone:503-232-1099
Mailing Address - Fax:
Practice Address - Street 1:30 NE MLK BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2941
Practice Address - Country:US
Practice Address - Phone:503-232-1099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000000729175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist