Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA1442 | TN |
NPI | 1023266400 |
---|---|
Provider Name | Amber Shonesy Sponaugle |
First Address | Seymour, TN 37865-3449 |
Second Address | Loudon, TN 37774-1575 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2008 |
Last Update Date | 30/07/2009 |