Healthcare Provider Details

I. General information

NPI: 1801456900
Provider Name (Legal Business Name): KATHERINE TATE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATIE TATE OTR/L

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

597 W FORREST AVE
JACKSON TN
38301
US

IV. Provider business mailing address

767 N TRENTON ST
RUTHERFORD TN
38369
US

V. Phone/Fax

Practice location:
  • Phone: 731-300-4800
  • Fax:
Mailing address:
  • Phone: 731-733-1187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6033
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: