Healthcare Provider Details

I. General information

NPI: 1801525787
Provider Name (Legal Business Name): SAVANNAH ENOCH OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/07/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

368 QUARRY LOOP ROAD
LEBANON TN
37090
US

IV. Provider business mailing address

127 N TARVER AVE APT B
LEBANON TN
37087-4660
US

V. Phone/Fax

Practice location:
  • Phone: 615-443-4445
  • Fax:
Mailing address:
  • Phone: 615-708-9171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7266
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: