Provider Demographics
NPI:1619089315
Name:BICKMORE, TAMMY LEE (OTR)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:LEE
Last Name:BICKMORE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 PREBLE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2236
Mailing Address - Country:US
Mailing Address - Phone:207-899-0171
Mailing Address - Fax:
Practice Address - Street 1:4 WINDING WAY
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8658
Practice Address - Country:US
Practice Address - Phone:207-883-1211
Practice Address - Fax:207-883-1211
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT 1002225X00000X
MA3584225X00000X
NH0680225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431773599Medicaid
ME431773599Medicaid