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General NPI Number Information
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NPI Number | 1174070742
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Entity Type | Individual
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Provider Name | GARY CRAIG LOVE OTL
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Gender | Male
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 4611 ASHEVILLE HWY
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City | KNOXVILLE
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State | TN
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Zip | 37914-3615
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Country | US
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Telephone | 865-329-3292
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Fax |
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Provider Business Mailing Address
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Address Line | 1710 MAURY ST
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City | ALCOA
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State | TN
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Zip | 37701-2032
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Country | US
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Telephone | 770-298-5841
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0000005048
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 225XG0600X
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Taxonomy Name | Gerontology Occupational Therapist
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License Number | OT001052
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License Number State | GA
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