Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT2688 | TN |
NPI | 1003807694 |
---|---|
Provider Name | Mr. Kyle Thomas Emerson |
First Address | Atlanta, GA 30348-5132 |
Second Address | Nashville, TN 37203-1821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 21/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3656390 | (05) | TN |