Healthcare Provider Details

I. General information

NPI: 1467620203
Provider Name (Legal Business Name): JODI PARKER O'HARA OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THE VANDERBILT CLINIC SUITE 1702
NASHVILLE TN
37232-0001
US

IV. Provider business mailing address

1401 DOUGLAS AVE
NASHVILLE TN
37206-2306
US

V. Phone/Fax

Practice location:
  • Phone: 615-343-6445
  • Fax:
Mailing address:
  • Phone: 615-227-7124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number2801
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: