1427212356 NPI number — MRS. TAMMY LYNN COLON MSOTR/L

Table of content: MRS. TAMMY LYNN COLON MSOTR/L (NPI 1427212356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427212356 NPI number — MRS. TAMMY LYNN COLON MSOTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLON
Provider First Name:
TAMMY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSOTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROSHEARS
Provider Other First Name:
TAMMY
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSOTR/L
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427212356
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3276
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47731-3276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-473-0181
Provider Business Mailing Address Fax Number:
812-473-5822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1169 EASTERN PKWY
Provider Second Line Business Practice Location Address:
SUITE 2313
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40217-1417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-309-9800
Provider Business Practice Location Address Fax Number:
502-309-9797
Provider Enumeration Date:
07/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  KY-R3839 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000972248 . This is a "ANTHEM BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 236445 . This is a "NATIONAL BOARD FOR CERTIFICATION N OCCUPATIONAL THERAPY INC.." identifier . This identifiers is of the category "OTHER".
  • Identifier: 7100369700 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132092 . This is a "LICENSE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 31004543A . This is a "INDIANA PROFESSIONAL LICENSING AGENCY FOR OCCUPATIONAL THERAPY" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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