Provider Demographics
NPI:1649428103
Name:KIRTON, TAMMY MARIE (COTA/L)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:MARIE
Last Name:KIRTON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:T
Other - Middle Name:
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA/L
Mailing Address - Street 1:18207 N 34TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-1013
Mailing Address - Country:US
Mailing Address - Phone:602-971-0607
Mailing Address - Fax:
Practice Address - Street 1:8115 E INDIAN BEND RD
Practice Address - Street 2:STE 123
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-4819
Practice Address - Country:US
Practice Address - Phone:480-951-6451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1728224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant