Provider Demographics
NPI:1972712297
Name:RICE, TRESA MESHON (COTA)
Entity type:Individual
Prefix:MISS
First Name:TRESA
Middle Name:MESHON
Last Name:RICE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 MCCARTT LOOP
Mailing Address - Street 2:
Mailing Address - City:CHUCKEY
Mailing Address - State:TN
Mailing Address - Zip Code:37641-5028
Mailing Address - Country:US
Mailing Address - Phone:423-787-6800
Mailing Address - Fax:
Practice Address - Street 1:119 MCCARTT LOOP
Practice Address - Street 2:
Practice Address - City:CHUCKEY
Practice Address - State:TN
Practice Address - Zip Code:37641-5028
Practice Address - Country:US
Practice Address - Phone:423-787-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0593320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities