Provider Demographics
NPI:1871741587
Name:PHILLIPS-BROOKSHIRE, TAMMY (OT ASSISTANT)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:PHILLIPS-BROOKSHIRE
Suffix:
Gender:F
Credentials:OT ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 SE 61ST ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73149-5005
Mailing Address - Country:US
Mailing Address - Phone:405-532-2179
Mailing Address - Fax:405-602-2392
Practice Address - Street 1:1601 SE 61ST ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73149-5005
Practice Address - Country:US
Practice Address - Phone:405-532-2179
Practice Address - Fax:405-602-2392
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK962224Z00000X
TX210055224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant