Healthcare Provider Details

I. General information

NPI: 1215592290
Provider Name (Legal Business Name): SUMMER RENEE' HOUCHIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 GALLAHER RD
KINGSTON TN
37763-4215
US

IV. Provider business mailing address

1324 LAWNVILLE RD
KINGSTON TN
37763-4728
US

V. Phone/Fax

Practice location:
  • Phone: 865-376-3416
  • Fax: 865-376-3532
Mailing address:
  • Phone: 865-376-3416
  • Fax: 865-376-3532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number5851
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5851
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: