Individual
MICHELLE SOUTHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3690 N MOUNT JULIET RD, MOUNT JULIET, TN 37122-3181
(615) 758-4888
Mailing address
106 POLLY ANN DR, MOUNT JULIET, TN 37122-6900
(615) 397-0378
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
3145
TN
Other
Enumeration date
10/03/2014
Last updated
10/03/2014
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