Provider Demographics
NPI:1457413072
Name:JETT, TAMMY ANN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:ANN
Last Name:JETT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2457 OLD PARRISH RD
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:AL
Mailing Address - Zip Code:35580
Mailing Address - Country:US
Mailing Address - Phone:205-295-0919
Mailing Address - Fax:
Practice Address - Street 1:1706 HIGHWAY 78 EAST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501
Practice Address - Country:US
Practice Address - Phone:205-221-3537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1765225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist