Provider Demographics
NPI:1578778056
Name:HAMPTON, TAMMY RENEE (MSP)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:RENEE
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:MSP
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:RENEE
Other - Last Name:MORRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MILLER
Mailing Address - State:MO
Mailing Address - Zip Code:65707-9248
Mailing Address - Country:US
Mailing Address - Phone:417-452-3515
Mailing Address - Fax:417-452-3264
Practice Address - Street 1:MILLER R-II
Practice Address - Street 2:110 W 6TH ST
Practice Address - City:MILLER
Practice Address - State:MO
Practice Address - Zip Code:65707-9248
Practice Address - Country:US
Practice Address - Phone:417-452-3515
Practice Address - Fax:417-452-3264
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001007190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO487476202Medicaid