MEDICARE: CINDY DUGGAN PETERSON COTA/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	224Z00000X	Occupational Therapy Assistant	3466	TN

General Provider Information

NPI Number	:	1992391239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CINDY DUGGAN PETERSON COTA/L

Provider Business Mailing Address
First Line	:	248 LAKE TERRACE DR
Second Line	:
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-5122
Country	:	US
Telephone Number	:	615-573-5569
Fax Number	:

Provider Business Practice Location Address
First Line	:	248 LAKE TERRACE DR
Second Line	:
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-5122
Country	:	US
Telephone Number	:	615-573-5569
Fax Number	:

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

Provider Enumeration Date	:	12/20/2020
Last Update Date	:	12/20/2020

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