Individual
D. SHANE FULMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.T.
Contact information
Practice address
260 FORT SANDERS WEST BLVD, SUITE 110, KNOXVILLE, TN 37922-3355
(865) 558-4491
(865) 558-4493
Mailing address
260 FORT SANDERS WEST BLVD, SUITE 110, KNOXVILLE, TN 37922-3355
(865) 558-4491
(865) 558-4493
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
748
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3656592
—
TN
01
—
4111141
BLUE CROSS BLUE SHIELD
TN
01
—
5942420
CIGNA
TN
Enumeration date
04/14/2006
Last updated
08/14/2020
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