MEDICARE: VANDERBILT CHILDREN'S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282NC2000X	Children's Hospital		TN

General Provider Information

NPI Number	:	1609056399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANDERBILT CHILDREN'S

Provider Business Mailing Address
First Line	:	1702 THE VANDERBILT CLINIC
Second Line	:	1301 22ND AVE SOUTH
City	:	NASHVILLE
State	:	TN
Zip	:	37232-0001
Country	:	US
Telephone Number	:	615-936-0730
Fax Number	:	615-936-7331

Provider Business Practice Location Address
First Line	:	1702 THE VANDERBILT CLINIC
Second Line	:	1301 22ND AVE SOUTH
City	:	NASHVILLE
State	:	TN
Zip	:	37232-0001
Country	:	US
Telephone Number	:	615-936-0730
Fax Number	:	615-936-7331

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	MISS DEBORAH ANNE POWERS
Credential	:	OTR/L
Telephone Number	:	615-936-0730

Provider Enumeration Date	:	11/09/2007
Last Update Date	:	11/09/2007

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Directions to “VANDERBILT CHILDREN'S ” Practice Location

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