Provider Demographics
NPI:1497206858
Name:MCILWAIN, DON ERICK (PTA)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:ERICK
Last Name:MCILWAIN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LABORATORY RD
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6911
Mailing Address - Country:US
Mailing Address - Phone:865-482-7698
Mailing Address - Fax:
Practice Address - Street 1:300 LABORATORY RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6911
Practice Address - Country:US
Practice Address - Phone:865-482-7698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2355174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist