Provider Demographics
NPI:1003187105
Name:PITTMAN, KATHLEEN ALICE
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ALICE
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 681478
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-1478
Mailing Address - Country:US
Mailing Address - Phone:615-591-6590
Mailing Address - Fax:
Practice Address - Street 1:5505 EDMONSON PIKE
Practice Address - Street 2:STE 103
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-5872
Practice Address - Country:US
Practice Address - Phone:615-831-1710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3622225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4318494OtherBCBS OF TENNESSEE
TN446631Medicare PIN
TN103I678528Medicare PIN