Provider Demographics
NPI:1386080497
Name:VANN, KATHY MICHELLE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:MICHELLE
Last Name:VANN
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 1:103 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:TN
Mailing Address - Zip Code:37185-1249
Mailing Address - Country:US
Mailing Address - Phone:931-622-0417
Mailing Address - Fax:
Practice Address - Street 1:895 POWERS BLVD
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-1018
Practice Address - Country:US
Practice Address - Phone:931-296-7552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1923224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant