Basic Information
| Provider Information | |||||||||
| NPI: | 1831467976 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JEFFERSON | ||||||||
| FirstName: | TAMMI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6101 S INGLESIDE AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606372619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7736435748 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1230 W LAKE ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606071602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126660028 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2011 | ||||||||
| LastUpdateDate: | 12/04/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 056.002672 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.