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General NPI Number Information
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NPI Number | 1437836426
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Entity Type | Individual
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Provider Name | KRIS B TWISDALE OTA
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Gender | Male
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Dates
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Enumeration Date | 06/30/2023
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Last Update Date | 06/30/2023
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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 | 9712 GRAND OAK WAY
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City | KNOXVILLE
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State | TN
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Zip | 37931-4800
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Country | US
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Telephone | 865-659-2216
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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 | OTA0000003749
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License Number State | TN
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