Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 3013 | TN |
NPI | 1013416452 |
---|---|
Provider Name | Jenna Dix |
First Address | Nashville, TN 37209-1226 |
Second Address | Nashville, TN 37221-4190 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2018 |
Last Update Date | 11/02/2018 |