Individual
CODY STOVALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
343 VANN DR, JACKSON, TN 38305-6018
(731) 984-7640
(731) 984-7660
Mailing address
343 VANN DR, JACKSON, TN 38305-6018
(731) 984-7640
(731) 984-7660
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4211
TN
Other
Enumeration date
04/09/2014
Last updated
04/09/2014
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