Provider Demographics
NPI:1659413938
Name:JOLLEY, TAMARA KAY (OTR)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:KAY
Last Name:JOLLEY
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 1:663 HIGHWAY 278 BYP
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:AR
Mailing Address - Zip Code:71671-9531
Mailing Address - Country:US
Mailing Address - Phone:870-226-5252
Mailing Address - Fax:
Practice Address - Street 1:663 HIGHWAY 278 BYP
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:AR
Practice Address - Zip Code:71671-9531
Practice Address - Country:US
Practice Address - Phone:870-226-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR375225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist