1770704769 NPI number — MRS. TAMMY FERRIERA OTR/L

Table of content: MRS. TAMMY FERRIERA OTR/L (NPI 1770704769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770704769 NPI number — MRS. TAMMY FERRIERA OTR/L

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FULLER
Provider Other First Name:
TAMMY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR/L
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770704769
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8374 HIGHWAY 89
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32570-9049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-543-3502
Provider Business Mailing Address Fax Number:
850-665-4318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8374 HIGHWAY 89
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32570-9049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-543-3502
Provider Business Practice Location Address Fax Number:
850-665-4318
Provider Enumeration Date:
05/01/2007

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: 222Q00000X , with the licence number:  OT12590 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: OT12590 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 112101500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com