MEDICARE: MS. IVY JOAN MCNEW 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
1	225X00000X	Occupational Therapist	OT0000000206	TN

General Provider Information

NPI Number	:	1982852356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IVY JOAN MCNEW OTR/L

Provider Business Mailing Address
First Line	:	3210 GARDEN DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37918-3318
Country	:	US
Telephone Number	:	865-687-3123
Fax Number	:

Provider Business Practice Location Address
First Line	:	3210 GARDEN DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37918-3318
Country	:	US
Telephone Number	:	865-687-3123
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2008
Last Update Date	:	08/28/2008

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