Provider Demographics
NPI:1538406863
Name:DENHAM, JAIME LYNNE (PTA)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:LYNNE
Last Name:DENHAM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:LYNNE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-362-8684
Practice Address - Street 1:8805 NEW HIGHWAY 68 UNIT 1
Practice Address - Street 2:
Practice Address - City:TELLICO PLAINS
Practice Address - State:TN
Practice Address - Zip Code:37385-3552
Practice Address - Country:US
Practice Address - Phone:423-253-3300
Practice Address - Fax:423-253-3947
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3189225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant