Provider Demographics
NPI:1285315200
Name:HAMMOCK, JAYCEE
Entity type:Individual
Prefix:
First Name:JAYCEE
Middle Name:
Last Name:HAMMOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 OKALONA RD
Mailing Address - Street 2:
Mailing Address - City:RICKMAN
Mailing Address - State:TN
Mailing Address - Zip Code:38580-1915
Mailing Address - Country:US
Mailing Address - Phone:931-397-9564
Mailing Address - Fax:
Practice Address - Street 1:887 WOODLAWN RD
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-5449
Practice Address - Country:US
Practice Address - Phone:931-287-2557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3990224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant