Provider Demographics
NPI:1689862187
Name:STELL, TAMMY KAY (MOT-OTR/L)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:KAY
Last Name:STELL
Suffix:
Gender:F
Credentials:MOT-OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 N GUADALUPE ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-5118
Mailing Address - Country:US
Mailing Address - Phone:505-302-7943
Mailing Address - Fax:
Practice Address - Street 1:513 S CANAL ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-5660
Practice Address - Country:US
Practice Address - Phone:575-887-6050
Practice Address - Fax:575-887-8908
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2061225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist