Provider Demographics
NPI:1205025210
Name:KLOPFENSTEIN, RICHARD LAWRENCE SR (COTA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LAWRENCE
Last Name:KLOPFENSTEIN
Suffix:SR
Gender:M
Credentials:COTA
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 475
Mailing Address - Street 2:
Mailing Address - City:DEER LODGE
Mailing Address - State:TN
Mailing Address - Zip Code:37726-0475
Mailing Address - Country:US
Mailing Address - Phone:800-330-7711
Mailing Address - Fax:
Practice Address - Street 1:444 ONE ELEVEN PLACE
Practice Address - Street 2:BETHESDA HEALTH CARE CENTER
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506-4358
Practice Address - Country:US
Practice Address - Phone:931-525-6655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOTA 1166224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant