Healthcare Provider Details

I. General information

NPI: 1598883134
Provider Name (Legal Business Name): SHARON DIANE LYTTLE OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 N MOUNT JULIET RD
MOUNT JULIET TN
37122-3061
US

IV. Provider business mailing address

426 BETH DR
MOUNT JULIET TN
37122-2042
US

V. Phone/Fax

Practice location:
  • Phone: 615-758-4888
  • Fax: 615-758-6188
Mailing address:
  • Phone: 615-758-0772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1744000000X
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: