Provider Demographics
NPI:1184998098
Name:HIGGINS, TAMMY LYNN (COTA)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N11981 COUNTY ROAD Y
Mailing Address - Street 2:
Mailing Address - City:CLINTONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54929-9241
Mailing Address - Country:US
Mailing Address - Phone:715-823-3170
Mailing Address - Fax:
Practice Address - Street 1:185 S CHET KRAUSE DR
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:WI
Practice Address - Zip Code:54945-9300
Practice Address - Country:US
Practice Address - Phone:715-445-2412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4877-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant