Healthcare Provider Details

I. General information

NPI: 1740430479
Provider Name (Legal Business Name): PATTI COOPER ORT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 CHURCH ST
NASHVILLE TN
37203-2000
US

IV. Provider business mailing address

1333 MCCLARDY RD
CLARKSVILLE TN
37042-6797
US

V. Phone/Fax

Practice location:
  • Phone: 615-515-4000
  • Fax:
Mailing address:
  • Phone: 931-647-6976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: