Healthcare Provider Details

I. General information

NPI: 1124435029
Provider Name (Legal Business Name): JOSHUA FOGLEMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2014
Last Update Date: 07/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E 10TH ST
SOUTH PITTSBURG TN
37380-1497
US

IV. Provider business mailing address

1029 JOHN HOOD DR
ROCKVALE TN
37153-4161
US

V. Phone/Fax

Practice location:
  • Phone: 423-837-7981
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4630
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: