Provider Demographics
NPI:1932416559
Name:WYATT, JAMIE SHERMAN (OMT)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:SHERMAN
Last Name:WYATT
Suffix:
Gender:F
Credentials:OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1847 COMMONS NORTH DR
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-3700
Mailing Address - Country:US
Mailing Address - Phone:205-344-3423
Mailing Address - Fax:
Practice Address - Street 1:100 PROFESSIONAL LN
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2393
Practice Address - Country:US
Practice Address - Phone:205-344-3423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2024-08-22
Deactivation Date:2021-06-02
Deactivation Code:
Reactivation Date:2024-08-22
Provider Licenses
StateLicense IDTaxonomies
AL3641225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist