Provider Demographics
NPI:1952867376
Name:WOODBERRY, TAMMY (COTA/L)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:WOODBERRY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:
Other - Last Name:NEMETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:2023 NE COOKSON ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-6307
Mailing Address - Country:US
Mailing Address - Phone:816-446-7646
Mailing Address - Fax:
Practice Address - Street 1:111 NW MOCK AVE STE OFF
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2504
Practice Address - Country:US
Practice Address - Phone:816-228-5655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004016782224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant