Individual
TRISTAN FAITH BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
136 DAVIS LN, LA FOLLETTE, TN 37766-3118
(423) 494-0550
Mailing address
2705 PINECREST RD, JACKSBORO, TN 37757-3103
(423) 494-0550
(423) 562-1055
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1588
TN
Other
Enumeration date
11/23/2012
Last updated
11/23/2012
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