Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 3708 | TN |
NPI | 1194281808 |
---|---|
Provider Name | Letitia Deneen Love |
First Address | Afton, TN 37616-6152 |
Second Address | Ooltewah, TN 37363-4435 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2019 |
Last Update Date | 18/02/2019 |