Individual
REBECCA BRIANE BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
2707 CITICO AVE, STE. B, CHATTANOOGA, TN 37406-3402
(423) 698-0853
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT4126
TN
Other
Enumeration date
10/14/2011
Last updated
10/14/2011
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