Provider Demographics
NPI:1982001442
Name:SIEGLAFF, TAMMY (OTR)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:SIEGLAFF
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 SHEFFIELD RD APT 204
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-6367
Mailing Address - Country:US
Mailing Address - Phone:414-550-6970
Mailing Address - Fax:
Practice Address - Street 1:S11W29667 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-9476
Practice Address - Country:US
Practice Address - Phone:262-565-6124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-28
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5434-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist