Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT2560 | TN |
NPI | 1003861345 |
---|---|
Provider Name | Candice Marie Barrentine |
First Address | Milan, TN 38358-0712 |
Second Address | Milan, TN 38358-6195 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 08/07/2007 |