Healthcare Provider Details

I. General information

NPI: 1164896445
Provider Name (Legal Business Name): PETER FRASER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2015
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 HEALTH CARE DR
CARTHAGE TN
37030-1168
US

IV. Provider business mailing address

1120 MONTROSE AVE UNIT 205
NASHVILLE TN
37204
US

V. Phone/Fax

Practice location:
  • Phone: 615-735-0569
  • Fax:
Mailing address:
  • Phone: 865-585-0105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5226
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: