Provider Demographics
NPI:1841742376
Name:WOOTEN, TAMMY (PTA)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39238 US HIGHWAY 271
Mailing Address - Street 2:
Mailing Address - City:WISTER
Mailing Address - State:OK
Mailing Address - Zip Code:74966-9018
Mailing Address - Country:US
Mailing Address - Phone:918-413-0178
Mailing Address - Fax:
Practice Address - Street 1:39238 US HIGHWAY 271
Practice Address - Street 2:
Practice Address - City:WISTER
Practice Address - State:OK
Practice Address - Zip Code:74966-9018
Practice Address - Country:US
Practice Address - Phone:918-413-0178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant