Provider Demographics
NPI:1528144672
Name:LINNEN, TAMMY JOHNSON (OTR-L)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:JOHNSON
Last Name:LINNEN
Suffix:
Gender:F
Credentials:OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 ELEMENTARY DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-6267
Mailing Address - Country:US
Mailing Address - Phone:910-678-2789
Mailing Address - Fax:910-678-2793
Practice Address - Street 1:396 ELEMENTARY DR
Practice Address - Street 2:EXCEPTIONAL CHILDREN'S SERVICES
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-6267
Practice Address - Country:US
Practice Address - Phone:910-678-2789
Practice Address - Fax:910-678-2793
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist