Healthcare Provider Details

I. General information

NPI: 1639554165
Provider Name (Legal Business Name): REBECCA GOLDMAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8904 CROSS PARK DR
KNOXVILLE TN
37923-4703
US

IV. Provider business mailing address

8823 PRODUCTION LN
OOLTEWAH TN
37363-6511
US

V. Phone/Fax

Practice location:
  • Phone: 865-690-2671
  • Fax: 865-690-6445
Mailing address:
  • Phone: 423-238-8930
  • Fax: 423-285-6647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5236
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: