Individual
MRS. CATHY LYNN OTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
500 LEBANON VALLEY CHURCH RD, CLEVELAND, TN 37311-8477
(423) 310-0555
(423) 479-4421
Mailing address
500 LEBANON VALLEY CHURCH RD, CLEVELAND, TN 37311-8477
(423) 310-0555
(423) 479-4421
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT0000002379
TN
225X00000X
Occupational Therapist
OT2379
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4130281
BCBS PROVIDER NO
TN
05
—
5441019
—
TN
01
—
OT2379
TN MEDICAL LICENSE
TN
Enumeration date
04/12/2007
Last updated
09/14/2010
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