Individual
DESTENEE KIMI-TAYLOR PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
501 MARTINDALE RD, BRISTOL, TN 37620-6152
(423) 340-1471
Mailing address
1091 EMBREVILLE RD, JOHNSON CITY, TN 37604-7046
(423) 340-1471
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
24083
FL
Other
Enumeration date
03/29/2023
Last updated
02/11/2025
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