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Individual

JILL RENEE BANNISTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
1018 W MAIN ST, LEBANON, TN 37087-3302
(615) 466-5200
(615) 466-5206
Mailing address
1616 W MAIN ST, LEBANON, TN 37087-3100
(615) 449-0990
(615) 449-0970

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
808
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
808
MEDICAL LICENSE, TN
TN
Enumeration date
08/09/2005
Last updated
09/13/2007
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