Provider Demographics
NPI:1770141301
Name:BUFFORD, TAMISHA
Entity type:Individual
Prefix:
First Name:TAMISHA
Middle Name:
Last Name:BUFFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMISHA
Other - Middle Name:
Other - Last Name:CAUSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:604 PAXTON AVE
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-3819
Mailing Address - Country:US
Mailing Address - Phone:773-603-9696
Mailing Address - Fax:
Practice Address - Street 1:604 PAXTON AVE
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-3819
Practice Address - Country:US
Practice Address - Phone:773-603-9696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty