Healthcare Provider Details

I. General information

NPI: 1396288304
Provider Name (Legal Business Name): EMILY KALISZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WALNUT LN
COLUMBIA TN
38401-4943
US

IV. Provider business mailing address

1030 LOWREY PL
SPRING HILL TN
37174-6118
US

V. Phone/Fax

Practice location:
  • Phone: 931-381-3112
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number6081
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: