Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 1870 | TN |
NPI | 1154593804 |
---|---|
Provider Name | Mr. Kenneth Christopher Massey |
First Address | Chattanooga, TN 37404-3322 |
Second Address | Hixson, TN 37343-4085 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2008 |
Last Update Date | 01/04/2008 |