Provider Demographics
NPI:1942447131
Name:PRICE, TAMMY A (OTR/L, CLVT)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:A
Last Name:PRICE
Suffix:
Gender:F
Credentials:OTR/L, CLVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17707 SAYRE AVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3908
Mailing Address - Country:US
Mailing Address - Phone:708-945-3165
Mailing Address - Fax:708-429-3167
Practice Address - Street 1:17049 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2739
Practice Address - Country:US
Practice Address - Phone:708-945-3165
Practice Address - Fax:708-429-3167
Is Sole Proprietor?:No
Enumeration Date:2009-01-10
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.004640225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist