Individual
BETH BOSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1128 E WEISGARBER RD, SUITE 100, KNOXVILLE, TN 37909-2674
(865) 579-0552
Mailing address
1812 SCENIC DR, MARYVILLE, TN 37803-6362
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1766
TN
Other
Enumeration date
12/19/2013
Last updated
12/19/2013
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