Provider Demographics
NPI:1336228758
Name:ACKLEY, TAMMY ALLINE
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:ALLINE
Last Name:ACKLEY
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 1:2462 HESS RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT ORAB
Mailing Address - State:OH
Mailing Address - Zip Code:45154-9544
Mailing Address - Country:US
Mailing Address - Phone:937-444-9607
Mailing Address - Fax:
Practice Address - Street 1:2462 HESS RD
Practice Address - Street 2:
Practice Address - City:MOUNT ORAB
Practice Address - State:OH
Practice Address - Zip Code:45154-9544
Practice Address - Country:US
Practice Address - Phone:937-444-9607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide