Healthcare Provider Details

I. General information

NPI: 1467910083
Provider Name (Legal Business Name): EMILY TAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4347 LEBANON PIKE
HERMITAGE TN
37076-1243
US

IV. Provider business mailing address

10133 SHERRILL BLVD
KNOXVILLE TN
37932-3347
US

V. Phone/Fax

Practice location:
  • Phone: 615-871-8283
  • Fax:
Mailing address:
  • Phone: 865-531-2204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3118
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: