Provider Demographics
NPI:1568782076
Name:BEGOTKA, TAMMIE L (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:L
Last Name:BEGOTKA
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30312 BEACHVIEW LN
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-3404
Mailing Address - Country:US
Mailing Address - Phone:708-699-8015
Mailing Address - Fax:
Practice Address - Street 1:3271 NORTH ST
Practice Address - Street 2:
Practice Address - City:EAST TROY
Practice Address - State:WI
Practice Address - Zip Code:53120-1147
Practice Address - Country:US
Practice Address - Phone:262-684-5153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4882-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4882-026OtherSTATE LICENSE