Individual
DR. JUSTIN ORAN MCDIVITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTD, R/L
Contact information
Practice address
815 S WALNUT AVE, COOKEVILLE, TN 38501-5956
(931) 646-7216
Mailing address
952 NOTTINGHAM DR, COOKEVILLE, TN 38506-4310
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4071
TN
Other
Enumeration date
11/30/2010
Last updated
11/30/2010
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