Provider Demographics
NPI:1427397009
Name:SLATER, BERNADETTE (OTR/L, CLT)
Entity Type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:
Last Name:SLATER
Suffix:
Gender:F
Credentials:OTR/L, CLT
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 405
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-0405
Mailing Address - Country:US
Mailing Address - Phone:423-320-3632
Mailing Address - Fax:
Practice Address - Street 1:6223 FLAG POINT DR
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-8376
Practice Address - Country:US
Practice Address - Phone:423-320-3632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-02
Last Update Date:2013-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT1710225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist