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General NPI Number Information
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NPI Number | 1255896205
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Entity Type | Individual
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Provider Name | KEVIN DANIEL KLEGG COTA/L
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Gender | Male
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Dates
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Enumeration Date | 02/04/2019
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Last Update Date | 02/12/2019
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Provider Practice Location Address
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Address Line | 5321 BEVERLY PARK CIR
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City | KNOXVILLE
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State | TN
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Zip | 37918-9253
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Country | US
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Telephone | 865-687-1321
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Fax |
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Provider Business Mailing Address
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Address Line | 5700 PLEASANT RIDGE RD APT 321
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City | KNOXVILLE
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State | TN
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Zip | 37912
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Country | US
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Telephone |
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 2674
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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