Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 00000312 | TN |
NPI | 1508300377 |
---|---|
Provider Name | Diana Jeanne Ledgett Brown |
First Address | Cleveland, TN 37323-6151 |
Second Address | Lenoir City, TN 37772-6447 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2016 |
Last Update Date | 14/12/2016 |