=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841631041
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPROCKET THERAPY SOLUTIONS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2013
-----------------------------------------------------
Last Update Date | 11/14/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 230 GREAT CIRCLE RD STE 202
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37228-1706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-226-2840
-----------------------------------------------------
Fax | 615-226-2839
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 60834
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37206-0834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-226-2840
-----------------------------------------------------
Fax | 615-226-2839
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BARBARA L TALBERT
-----------------------------------------------------
Credential | OTR/L
-----------------------------------------------------
Telephone | 615-226-2840
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 4107
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------