Individual
MARGO ELENA VANDER WOUDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
10875 MOSS BRANCH RD, BON AQUA, TN 37025-3149
(615) 516-3794
Mailing address
10875 MOSS BRANCH RD, BON AQUA, TN 37025-3149
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2942
TN
Other
Enumeration date
08/16/2017
Last updated
05/18/2020
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