Healthcare Provider Details

I. General information

NPI: 1912346313
Provider Name (Legal Business Name): CONSTANCE ELAM OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CONSTANCE RIGDON OT

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 10/26/2026
Certification Date: 10/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2851 STAGE VILLAGE CV STE 2
BARTLETT TN
38134-4683
US

IV. Provider business mailing address

2651 SURREY WOOD DR
BARTLETT TN
38134-5579
US

V. Phone/Fax

Practice location:
  • Phone: 901-949-9488
  • Fax:
Mailing address:
  • Phone: 662-897-3059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5594
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT2571
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: