Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 2792 | TN |
NPI | 1902569239 |
---|---|
Provider Name | Mrs. Paula Waggoner Vergne |
First Address | Franklin, TN 37064-2296 |
Second Address | Franklin, TN 37064-2296 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2021 |
Last Update Date | 13/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2792 | STATE OF TN-BOARD OF OCCUPATIONAL THERAPY (01) | TN |