Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 3847 | TN |
NPI | 1003210576 |
---|---|
Provider Name | Misty Seehorn |
First Address | Johnson City, TN 37604-6652 |
Second Address | Johnson City, TN 37601-1515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2014 |
Last Update Date | 13/10/2014 |