Provider Demographics
NPI:1548551948
Name:CRUTCHFIELD, TAMMY S (OTR)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:S
Last Name:CRUTCHFIELD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 THE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BLACKSTONE
Mailing Address - State:VA
Mailing Address - Zip Code:23824-4032
Mailing Address - Country:US
Mailing Address - Phone:434-294-1558
Mailing Address - Fax:
Practice Address - Street 1:930 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKSTONE
Practice Address - State:VA
Practice Address - Zip Code:23824-2614
Practice Address - Country:US
Practice Address - Phone:434-292-4268
Practice Address - Fax:434-292-7406
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000139225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist