Provider Demographics
NPI:1316722671
Name:DEVINE-QIN, METTA
Entity type:Individual
Prefix:
First Name:METTA
Middle Name:
Last Name:DEVINE-QIN
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 1:1450 CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-4112
Mailing Address - Country:US
Mailing Address - Phone:615-314-7665
Mailing Address - Fax:
Practice Address - Street 1:113 CUMBERLAND AVE STE 110
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-3339
Practice Address - Country:US
Practice Address - Phone:615-596-1830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7597225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist