Provider Demographics
NPI:1972823466
Name:SMITH, TAMMY JO (OTD, OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:TAMMY
Middle Name:JO
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:MISS
Other - First Name:TAMMY
Other - Middle Name:JO
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR/L
Mailing Address - Street 1:328 BRENLEIGH CT
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-7421
Mailing Address - Country:US
Mailing Address - Phone:717-279-1067
Mailing Address - Fax:
Practice Address - Street 1:201 OBERLIN RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:PA
Practice Address - Zip Code:17057-3014
Practice Address - Country:US
Practice Address - Phone:717-948-3370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009350225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist