Provider Demographics
NPI:1457776205
Name:KUSHER, TAMMY JO (BA)
Entity Type:Individual
Prefix:
First Name:TAMMY JO
Middle Name:
Last Name:KUSHER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 LYDALL ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-2354
Mailing Address - Country:US
Mailing Address - Phone:860-478-3000
Mailing Address - Fax:
Practice Address - Street 1:148 LYDALL ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-2354
Practice Address - Country:US
Practice Address - Phone:860-478-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT113390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program