Individual
DETRAVES NEVILLE THICKLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
210 WALMART DR, STE 100, SODDY DAISY, TN 37379-5022
(423) 332-9490
(423) 332-3817
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
(423) 362-8684
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
TN
Other
Enumeration date
12/01/2016
Last updated
12/01/2016
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