Provider Demographics
NPI:1013108570
Name:HUBBARD, TAMMY LYN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:LYN
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18289 TUPELO RIDGE TER
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-6826
Mailing Address - Country:US
Mailing Address - Phone:941-882-2040
Mailing Address - Fax:
Practice Address - Street 1:18289 TUPELO RIDGE TER
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-6826
Practice Address - Country:US
Practice Address - Phone:941-882-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002178225X00000X
DC941225X00000X
MD3880225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist