Provider Demographics
NPI:1992009302
Name:MARSH, TAMMY JOAN (ATC)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:JOAN
Last Name:MARSH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:T
Other - Middle Name:J
Other - Last Name:MARSH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:500 CARLEN AVE
Mailing Address - Street 2:APT #7224
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-4222
Mailing Address - Country:US
Mailing Address - Phone:931-397-6911
Mailing Address - Fax:
Practice Address - Street 1:104 SALUDA POINTE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7295
Practice Address - Country:US
Practice Address - Phone:803-227-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC020354146L00000X
SC11582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic