Provider Demographics
NPI:1992967764
Name:COLVER, TAMMY JEAN (OT/L)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:JEAN
Last Name:COLVER
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2343 GAREY LN
Mailing Address - Street 2:
Mailing Address - City:FILER
Mailing Address - State:ID
Mailing Address - Zip Code:83328-5543
Mailing Address - Country:US
Mailing Address - Phone:208-941-1475
Mailing Address - Fax:
Practice Address - Street 1:630 ADDISON AVE W
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5491
Practice Address - Country:US
Practice Address - Phone:208-737-2975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-215225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDOT-215OtherIDAHO STATE BOARD OF MEDICINE -OT