Provider Demographics
NPI:1073943692
Name:JORGENSEN, METTE WEISS (OTR/L)
Entity Type:Individual
Prefix:
First Name:METTE
Middle Name:WEISS
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:OTR/L
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 60834
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-0834
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:604 GALLATIN AVE
Practice Address - Street 2:STE 205
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-3237
Practice Address - Country:US
Practice Address - Phone:615-750-3556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4865225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist