Provider Demographics
NPI:1801233630
Name:WEBB, TAMMY SUE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:SUE
Last Name:WEBB
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:TAMMY
Other - Middle Name:SUE
Other - Last Name:POTTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:875 N EDGEMERE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914
Mailing Address - Country:US
Mailing Address - Phone:219-781-4158
Mailing Address - Fax:
Practice Address - Street 1:70 KEN HAYES DR
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-9379
Practice Address - Country:US
Practice Address - Phone:708-829-0059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000499A225X00000X
IL056.002551225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist