Provider Demographics
NPI:1205390465
Name:BALDOCK, WILLIAM DOUGLAS
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DOUGLAS
Last Name:BALDOCK
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 1:2302 MONTEREY LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912-4633
Mailing Address - Country:US
Mailing Address - Phone:865-525-4808
Mailing Address - Fax:
Practice Address - Street 1:2302 MONTEREY LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37912-4633
Practice Address - Country:US
Practice Address - Phone:888-531-2204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOTA0000000600224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant