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General NPI Number Information
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NPI Number | 1629360375
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Entity Type | Organization
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Legal Business Name | WEST TENNESSEE REGIONAL OFFICE
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Dates
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Enumeration Date | 05/12/2011
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Last Update Date | 05/12/2011
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Provider Practice Location Address
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Address Line | 11293 MEMPHIS ARLINGTON RD
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City | ARLINGTON
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State | TN
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Zip | 38002-7978
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Country | US
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Telephone | 901-745-7573
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Fax | 901-745-7468
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Provider Business Mailing Address
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Address Line | P.O BOX 949 11293 MEMPHIS ARLINGTON RD
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City | ARLINGTON
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State | TN
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Zip | 38002
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Country | US
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Telephone | 901-745-7573
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Fax | 901-745-7468
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MRS. ANJALI VASISHTA
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Credential | OTR/L
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Telephone | 901-745-7573
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | OT1340
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License Number State | TN
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