Provider Demographics
NPI:1669628145
Name:HICKS, TAMMIE LYNN (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:TAMMIE
Middle Name:LYNN
Last Name:HICKS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:TAMMIE
Other - Middle Name:LYNN
Other - Last Name:SCHNOOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:704 LYNDHURST ST UNIT 604
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-7769
Mailing Address - Country:US
Mailing Address - Phone:727-223-3930
Mailing Address - Fax:
Practice Address - Street 1:2759 SR 580 STE 112
Practice Address - Street 2:PEDIATRIC THERAPYWORKS
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761
Practice Address - Country:US
Practice Address - Phone:727-724-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOA1877224Z00000X
FLOTA000488224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant