Healthcare Provider Details

I. General information

NPI: 1609702927
Provider Name (Legal Business Name): HEIDI CHRISTINE CANOSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 BIG STATION CAMP BLVD STE 208
GALLATIN TN
37066-8466
US

IV. Provider business mailing address

225 BIG STATION CAMP BLVD STE 208
GALLATIN TN
37066-8466
US

V. Phone/Fax

Practice location:
  • Phone: 615-328-5502
  • Fax: 615-328-6115
Mailing address:
  • Phone: 615-328-5502
  • Fax: 615-328-6115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2515
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: