MEDICARE: DUSTIN SNOW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA0000004252	TN
2	225X00000X	Occupational Therapist	5115	TN

General Provider Information

NPI Number	:	1447428826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSTIN SNOW

Provider Business Mailing Address
First Line	:	1028 CAMP AUSTIN RD
Second Line	:
City	:	OAKDALE
State	:	TN
Zip	:	37829-2924
Country	:	US
Telephone Number	:	865-956-9734
Fax Number	:

Provider Business Practice Location Address
First Line	:	1028 CAMP AUSTIN RD
Second Line	:
City	:	OAKDALE
State	:	TN
Zip	:	37829-2924
Country	:	US
Telephone Number	:	865-356-9734
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	10/04/2025

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Directions to “ DUSTIN SNOW ” Practice Location

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