Provider Demographics
NPI:1578688776
Name:MCCORT, TAMMY J
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:J
Last Name:MCCORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54912 TEMPERANCEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43713-9650
Mailing Address - Country:US
Mailing Address - Phone:740-679-3417
Mailing Address - Fax:
Practice Address - Street 1:54912 TEMPERANCEVILLE HWY
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43713-9650
Practice Address - Country:US
Practice Address - Phone:740-679-3417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHT10193747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2466620Medicaid