Provider Demographics
NPI:1740529395
Name:TALLMAN, MATTHEW (OTR/L)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:TALLMAN
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3379 ROCK HOLD RD
Mailing Address - Street 2:
Mailing Address - City:BLUFF CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37618-3501
Mailing Address - Country:US
Mailing Address - Phone:423-366-1994
Mailing Address - Fax:
Practice Address - Street 1:302 WESLEY ST
Practice Address - Street 2:SUITE 8
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1740
Practice Address - Country:US
Practice Address - Phone:423-282-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist