Provider Demographics
NPI:1194074708
Name:CLEARY, TAMMY GAIL (OT)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:GAIL
Last Name:CLEARY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:G
Other - Last Name:KOZMENSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11296 WINDSOR CT
Mailing Address - Street 2:
Mailing Address - City:IJAMSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21754-8812
Mailing Address - Country:US
Mailing Address - Phone:240-285-8963
Mailing Address - Fax:
Practice Address - Street 1:844 WASHINGTON RD STE 209
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6876
Practice Address - Country:US
Practice Address - Phone:410-876-5600
Practice Address - Fax:410-876-1623
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04829225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist