Provider Demographics
NPI:1952923237
Name:TRAHERN, TAMMY MARIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:MARIE
Last Name:TRAHERN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W 33RD ST
Mailing Address - Street 2:
Mailing Address - City:HIGGINSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64037-1833
Mailing Address - Country:US
Mailing Address - Phone:660-909-6107
Mailing Address - Fax:
Practice Address - Street 1:536 S BUSINESS HIGHWAY 13
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MO
Practice Address - Zip Code:64067-1438
Practice Address - Country:US
Practice Address - Phone:660-251-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-10
Last Update Date:2020-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012001560224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant