Provider Demographics
NPI:1295574085
Name:NETHERCOTT, TAMMY
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:NETHERCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 MYGATT RD
Mailing Address - Street 2:
Mailing Address - City:AMENIA
Mailing Address - State:NY
Mailing Address - Zip Code:12501-5300
Mailing Address - Country:US
Mailing Address - Phone:914-391-2603
Mailing Address - Fax:
Practice Address - Street 1:109 MYGATT RD
Practice Address - Street 2:
Practice Address - City:AMENIA
Practice Address - State:NY
Practice Address - Zip Code:12501-5300
Practice Address - Country:US
Practice Address - Phone:914-391-2603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251C00000XAgenciesDay Training, Developmentally Disabled Services