Provider Demographics
NPI:1700257961
Name:HAMMOND, TIFFANY (ATC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 PAYNE KOEHLER RD
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-9450
Mailing Address - Country:US
Mailing Address - Phone:812-941-2099
Mailing Address - Fax:
Practice Address - Street 1:2020 PAYNE KOEHLER RD
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-9450
Practice Address - Country:US
Practice Address - Phone:812-941-2099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000984A2255A2300X
KYAT7762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer