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: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 PROFESSIONAL PLZ STE 101
GERMANTOWN TN
38138-1534
US

IV. Provider business mailing address

8767 OVERCUP OAKS DR
CORDOVA TN
38018-0427
US

V. Phone/Fax

Practice location:
  • Phone: 901-328-2104
  • Fax:
Mailing address:
  • Phone: 662-897-3059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: