Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 3486 | TN |
NPI | 1063916476 |
---|---|
Provider Name | Mrs. Heather Kavanaugh Winters |
First Address | Nashville, TN 37204-4701 |
Second Address | Nashville, TN 37204-4689 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2018 |
Last Update Date | 15/10/2020 |