Healthcare Provider Details

I. General information

NPI: 1609014356
Provider Name (Legal Business Name): KELLY M WRIGHT COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CAVETTE HILL LN
KNOXVILLE TN
37934-6673
US

IV. Provider business mailing address

393 LEWALLEN HOLLOW LN
CLINTON TN
37716-6522
US

V. Phone/Fax

Practice location:
  • Phone: 865-777-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1781
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number105997
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: