Provider Demographics
NPI:1194060491
Name:CARACCIOLO, NATALIE HARGETT
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:HARGETT
Last Name:CARACCIOLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25385 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:TN
Mailing Address - Zip Code:38449
Mailing Address - Country:US
Mailing Address - Phone:931-427-2143
Mailing Address - Fax:931-427-2186
Practice Address - Street 1:25385 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:TN
Practice Address - Zip Code:38449
Practice Address - Country:US
Practice Address - Phone:931-427-2143
Practice Address - Fax:931-427-2186
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1535224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant