Healthcare Provider Details

I. General information

NPI: 1609056399
Provider Name (Legal Business Name): VANDERBILT CHILDREN'S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 THE VANDERBILT CLINIC 1301 22ND AVE SOUTH
NASHVILLE TN
37232-0001
US

IV. Provider business mailing address

1702 THE VANDERBILT CLINIC 1301 22ND AVE SOUTH
NASHVILLE TN
37232-0001
US

V. Phone/Fax

Practice location:
  • Phone: 615-936-0730
  • Fax: 615-936-7331
Mailing address:
  • Phone: 615-936-0730
  • Fax: 615-936-7331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number
License Number StateTN

VIII. Authorized Official

Name: MISS DEBORAH ANNE POWERS
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 615-936-0730