Healthcare Provider Details

I. General information

NPI: 1174070742
Provider Name (Legal Business Name): GARY CRAIG LOVE OTL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4611 ASHEVILLE HWY
KNOXVILLE TN
37914-3615
US

IV. Provider business mailing address

1710 MAURY ST
ALCOA TN
37701-2032
US

V. Phone/Fax

Practice location:
  • Phone: 865-329-3292
  • Fax:
Mailing address:
  • Phone: 770-298-5841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0000005048
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOT001052
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: