Provider Demographics
NPI:1629101803
Name:TRAMMELL, TINA LAWREN (OTR, CKTP)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:LAWREN
Last Name:TRAMMELL
Suffix:
Gender:F
Credentials:OTR, CKTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 WYNDHAM WAY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3418
Mailing Address - Country:US
Mailing Address - Phone:832-367-3888
Mailing Address - Fax:
Practice Address - Street 1:810 S MASON RD STE 101
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-3857
Practice Address - Country:US
Practice Address - Phone:281-392-7811
Practice Address - Fax:281-392-3990
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110465225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160295501Medicaid
TX160295501Medicaid
TX8A3238Medicare ID - Type Unspecified