Provider Demographics
NPI:1891387213
Name:PALMER, TAMMI RENEE (PTA)
Entity Type:Individual
Prefix:
First Name:TAMMI
Middle Name:RENEE
Last Name:PALMER
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:PO BOX 3675
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74802-3675
Mailing Address - Country:US
Mailing Address - Phone:405-214-0300
Mailing Address - Fax:
Practice Address - Street 1:20926 SE 29TH ST STE C
Practice Address - Street 2:
Practice Address - City:HARRAH
Practice Address - State:OK
Practice Address - Zip Code:73045-6610
Practice Address - Country:US
Practice Address - Phone:405-391-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK685225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant