Provider Demographics
NPI:1245673144
Name:STILL, TAMMY J (LMT)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:J
Last Name:STILL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 W HARVARD AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-2716
Mailing Address - Country:US
Mailing Address - Phone:541-430-1748
Mailing Address - Fax:
Practice Address - Street 1:1701 W HARVARD AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2716
Practice Address - Country:US
Practice Address - Phone:541-430-1748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12077225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist