Provider Demographics
NPI:1902965023
Name:MILEY, KARISSA NICOLE FAYE (COTAL)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:NICOLE FAYE
Last Name:MILEY
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 N WOODDALE RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37924-2918
Mailing Address - Country:US
Mailing Address - Phone:865-933-4622
Mailing Address - Fax:
Practice Address - Street 1:3305 W END AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1035
Practice Address - Country:US
Practice Address - Phone:615-386-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4487046224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant