Provider Demographics
NPI:1245444249
Name:LANE, TAMMY ANNETTE (OTRL)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:ANNETTE
Last Name:LANE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 KY HIGHWAY 1247
Mailing Address - Street 2:P. O. BOX 596
Mailing Address - City:STANFORD
Mailing Address - State:KY
Mailing Address - Zip Code:40484-7860
Mailing Address - Country:US
Mailing Address - Phone:606-669-4667
Mailing Address - Fax:
Practice Address - Street 1:203 EAST HOLLY
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:WY
Practice Address - Zip Code:82331-0883
Practice Address - Country:US
Practice Address - Phone:307-326-8212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOTR-710225X00000X
KYKY-R2537225X00000X
PAOC009807225X00000X
MT983225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist