Healthcare Provider Details

I. General information

NPI: 1154353373
Provider Name (Legal Business Name): KARYN R HENDERSON OTR L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 EAGLE POINT DR
ROCKWOOD TN
37854-5630
US

IV. Provider business mailing address

136 EAGLE POINT DR PO BOX 806
ROCKWOOD TN
37854-5630
US

V. Phone/Fax

Practice location:
  • Phone: 865-310-3013
  • Fax: 865-310-3013
Mailing address:
  • Phone: 865-310-3013
  • Fax: 865-310-3013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 2516
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: