Provider Demographics
NPI:1417402777
Name:MCCLARNON, TRISTA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:TRISTA
Middle Name:
Last Name:MCCLARNON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4713 RICHMAR CT
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4341
Mailing Address - Country:US
Mailing Address - Phone:615-481-7508
Mailing Address - Fax:
Practice Address - Street 1:4713 RICHMAR CT
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4341
Practice Address - Country:US
Practice Address - Phone:615-481-7508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3799225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation