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General NPI Number Information
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NPI Number | 1639778111
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Entity Type | Individual
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Provider Name | MARY CHARLOTTE BRACKNEY COTA/L
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Gender | Female
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 801 E INSKIP DR
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City | KNOXVILLE
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State | TN
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Zip | 37912-3734
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Country | US
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Telephone | 865-357-1660
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Fax |
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Provider Business Mailing Address
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Address Line | 6312 HUGH WILLIS RD
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City | POWELL
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State | TN
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Zip | 37849-5612
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Country | US
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Telephone | 931-267-4327
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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 | 2919
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License Number State | TN
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