Healthcare Provider Details

I. General information

NPI: 1952729733
Provider Name (Legal Business Name): MRS. ANNA UNDERWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3690 N MOUNT JULIET RD SUITE 400
MOUNT JULIET TN
37122-3181
US

IV. Provider business mailing address

3690 N MOUNT JULIET RD SUITE 400
MOUNT JULIET TN
37122-3181
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4894
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: