Provider Demographics
NPI:1023123304
Name:BOHUSLAW, TAMMY ANN (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:TAMMY
Middle Name:ANN
Last Name:BOHUSLAW
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 1:20 S PARK AVE
Mailing Address - Street 2:STE A
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4269
Mailing Address - Country:US
Mailing Address - Phone:407-880-8348
Mailing Address - Fax:
Practice Address - Street 1:20 S PARK AVE
Practice Address - Street 2:STE A
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4269
Practice Address - Country:US
Practice Address - Phone:407-880-8348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT3698225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3698OtherLICENSE #