Provider Demographics
NPI:1164896445
Name:FRASER, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:FRASER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 MONTROSE AVE
Mailing Address - Street 2:UNIT 205
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204
Mailing Address - Country:US
Mailing Address - Phone:865-585-0105
Mailing Address - Fax:
Practice Address - Street 1:112 HEALTH CARE DR
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-1168
Practice Address - Country:US
Practice Address - Phone:615-735-0569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5226225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist