Provider Demographics
NPI:1699047613
Name:MAYFIELD, TAMMI H (OT)
Entity type:Individual
Prefix:MRS
First Name:TAMMI
Middle Name:H
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:TAMMI
Other - Middle Name:SUE
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2701 N GRAPEVINE MILLS BLVD APT 2212
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-2071
Mailing Address - Country:US
Mailing Address - Phone:616-836-8688
Mailing Address - Fax:
Practice Address - Street 1:2535 IRA E WOODS AVE
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051
Practice Address - Country:US
Practice Address - Phone:817-481-2121
Practice Address - Fax:817-488-4493
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101867172V00000X
225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty