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General NPI Number Information
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NPI Number | 1639546104
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Entity Type | Individual
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Provider Name | LAURA VETTER
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Gender | Female
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Dates
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Enumeration Date | 08/31/2015
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 139 MAPLE ROW BLVD STE 202
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-4492
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Country | US
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Telephone | 208-310-0296
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Fax |
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Provider Business Mailing Address
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Address Line | 605 DOROTHY DR APT A
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City | GOODLETTSVILLE
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State | TN
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Zip | 37072-3416
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT-921
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT 00003794
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT3512
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License Number State | TN
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