Organization
SUSAN C CARNAHAN LAKE BUM DELIVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN CARNAHAN OT (OWNER)
(865) 207-7855
Entity
Organization
Contact information
Practice address
1454 FRANCIS STATION DR, KNOXVILLE, TN 37909-1123
(865) 207-7855
Mailing address
1454 FRANCIS STATION DR, KNOXVILLE, TN 37909-1123
(865) 207-7855
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1142
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1142
STATE LICENSE
TN
Enumeration date
06/11/2018
Last updated
06/11/2018
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