=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467224675
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JORDAN CHASE ROSEMORE OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2023
-----------------------------------------------------
Last Update Date | 11/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 144 COLLEGE ST
-----------------------------------------------------
City | GALLATIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37066-3808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-802-8051
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4531 HIGHWAY 76 W
-----------------------------------------------------
City | ADAMS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37010-5037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-494-4158
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 7814
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------