Healthcare Provider Details

I. General information

NPI: 1336561059
Provider Name (Legal Business Name): COREY AARON HECK COTA/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 S GAY ST
KNOXVILLE TN
37902-1814
US

IV. Provider business mailing address

912 S GAY ST
KNOXVILLE TN
37902-1814
US

V. Phone/Fax

Practice location:
  • Phone: 865-594-1540
  • Fax: 865-594-1531
Mailing address:
  • Phone: 865-594-1540
  • Fax: 865-594-1531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0000001989
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: