Individual
TAMMIE HINTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA/L,LMT
Contact information
Practice address
1404 GOLF PARK DR, LAKE ARIEL, PA 18436-4252
(570) 698-5647
Mailing address
1404 GOLF PARK DR, LAKE ARIEL, PA 18436-4252
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OP002861L
PA
225700000X
Massage Therapist
MSG007870
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101802
FACILITY LICENSE NUMBER
PA
05
—
102602636-0001
—
PA
Enumeration date
07/24/2014
Last updated
07/24/2014
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