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NPI Code Detail

MEDICARE: MS. MARIAH PETTIT MED.,OTR/L

MEDICARE: MS. MARIAH PETTIT MED.,OTR/L
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
1225XP0200XPediatric Occupational TherapistOC005816LPA
2225XP0200XPediatric Occupational TherapistOT94ME
3225X00000XOccupational Therapist5666TN

General Provider Information

NPI Number : 1952380339
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARIAH PETTIT MED.,OTR/L
Provider Business Mailing Address
First Line : 1173 ROCK SPRINGS RD STE 105
Second Line :
City : SMYRNA
State : TN
Zip : 37167-8414
Country : US
Telephone Number : 615-220-5796
Fax Number :
Provider Business Practice Location Address
First Line : 1173 ROCK SPRINGS RD STE 105
Second Line :
City : SMYRNA
State : TN
Zip : 37167-8414
Country : US
Telephone Number : 615-220-5796
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2006
Last Update Date : 03/07/2024

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