Healthcare Provider Details

I. General information

NPI: 1376290130
Provider Name (Legal Business Name): MEGAN TREADWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 03/02/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10133 SHERRILL BLVD STE 200
KNOXVILLE TN
37932-3347
US

IV. Provider business mailing address

10133 SHERRILL BLVD STE 200
KNOXVILLE TN
37932-3347
US

V. Phone/Fax

Practice location:
  • Phone: 865-531-2204
  • Fax:
Mailing address:
  • Phone: 865-392-2829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: