Individual
MARY BETH HODGE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
O.T.
Contact information
Practice address
260 FORT SANDERS WEST BLVD, SUITE 110, KNOXVILLE, TN 37922-3355
(865) 558-4491
(865) 558-4493
Mailing address
260 FORT SANDERS WEST BLVD, KNOXVILLE, TN 37922-3355
(865) 769-4545
(865) 769-4501
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1807
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3645932
—
TN
01
—
4111080
BLUE CROSS BLUE SHIELD
TN
Enumeration date
04/13/2006
Last updated
07/08/2007
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