Provider Demographics
NPI:1396965257
Name:JOHNSON, TAMMIE KAY (OTR)
Entity type:Individual
Prefix:
First Name:TAMMIE
Middle Name:KAY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:TAMMIE
Other - Middle Name:KAY
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:3714 WOODSIDE RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-2430
Mailing Address - Country:US
Mailing Address - Phone:972-939-6224
Mailing Address - Fax:
Practice Address - Street 1:9441 LYNDON B JOHNSON FWY STE 101
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-4566
Practice Address - Country:US
Practice Address - Phone:214-575-9820
Practice Address - Fax:214-575-9846
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102638225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist