Healthcare Provider Details

I. General information

NPI: 1356756738
Provider Name (Legal Business Name): LIFE OCCUPATIONAL THERAPY SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 06/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 N 9TH ST
NASHVILLE TN
37206-3905
US

IV. Provider business mailing address

621 N 9TH ST
NASHVILLE TN
37206-3905
US

V. Phone/Fax

Practice location:
  • Phone: 843-860-0541
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number3706
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number3706
License Number StateTN

VIII. Authorized Official

Name: MRS. MARNIQUE RILEY STRICKLAND
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 843-860-0541