Provider Demographics
NPI:1063194504
Name:COSBY, RHAVEN ALYSON (COTA/L)
Entity type:Individual
Prefix:
First Name:RHAVEN
Middle Name:ALYSON
Last Name:COSBY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 PARKS CIR
Mailing Address - Street 2:
Mailing Address - City:HARROGATE
Mailing Address - State:TN
Mailing Address - Zip Code:37752-7035
Mailing Address - Country:US
Mailing Address - Phone:423-419-0216
Mailing Address - Fax:
Practice Address - Street 1:122 CAVETTE HILL LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-6674
Practice Address - Country:US
Practice Address - Phone:865-777-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4002224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant