Provider Demographics
NPI:1134859077
Name:BUXKEMPER, TAMMY SUE (COTA)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:SUE
Last Name:BUXKEMPER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3770 PENTEL CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30360-1537
Mailing Address - Country:US
Mailing Address - Phone:404-906-1142
Mailing Address - Fax:
Practice Address - Street 1:10133 SHERRILL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-3347
Practice Address - Country:US
Practice Address - Phone:404-906-1142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001012224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant