Provider Demographics
NPI:1538146220
Name:SCAMMACCA, TISHA ERIN
Entity type:Individual
Prefix:MRS
First Name:TISHA
Middle Name:ERIN
Last Name:SCAMMACCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TISHA
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8819 E 57TH ST
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133
Mailing Address - Country:US
Mailing Address - Phone:816-743-9518
Mailing Address - Fax:
Practice Address - Street 1:2100 SWIFT AVE
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116
Practice Address - Country:US
Practice Address - Phone:816-474-8877
Practice Address - Fax:816-474-8878
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003001814225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant