Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 4696 | TN |
NPI | 1154756872 |
---|---|
Provider Name | Mrs. Brandy Michelle Lockard |
First Address | Knoxville, TN 37918-8159 |
Second Address | Knoxville, TN 37909-1135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2013 |
Last Update Date | 12/09/2013 |