Healthcare Provider Details

I. General information

NPI: 1063613867
Provider Name (Legal Business Name): LYTTLE FOX THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 08/22/2020
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

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHARON D LYTTLE
Title or Position: OWNER
Credential: OTRL
Phone: 615-758-4888