Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 3622 | TN |
NPI | 1003187105 |
---|---|
Provider Name | Kathleen Alice Pittman |
First Address | Franklin, TN 37068-1478 |
Second Address | Nashville, TN 37211-5872 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2012 |
Last Update Date | 16/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4318494 | BCBS OF TENNESSEE (01) | TN |