Individual
MR. SHANE PRATER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
136 DAVIS LN, LA FOLLETTE, TN 37766-3118
(423) 562-4760
Mailing address
136 DAVIS LN, LA FOLLETTE, TN 37766-3118
(423) 562-4760
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2132
TN
Other
Enumeration date
06/20/2013
Last updated
06/20/2013
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