Healthcare Provider Details

I. General information

NPI: 1972988897
Provider Name (Legal Business Name): KIMBERLY MICHELLE MUSICANTE OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8426 SPRINGER DR
CORDOVA TN
38018-6823
US

IV. Provider business mailing address

8426 SPRINGER DR
CORDOVA TN
38018-6823
US

V. Phone/Fax

Practice location:
  • Phone: 901-825-7788
  • Fax: 901-624-8715
Mailing address:
  • Phone: 901-825-7788
  • Fax: 901-624-8715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number0863
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: