Individual
MARLEA TYLER PRIDEMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2412 KNOB CREEK RD, JOHNSON CITY, TN 37604-2586
(423) 518-0002
Mailing address
44 KNOLL DR APT C2, BRISTOL, VA 24202-2769
(277) 451-1915
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3548
TN
Other
Enumeration date
06/01/2021
Last updated
06/01/2021
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