Provider Demographics
NPI:1508353541
Name:COX, MINDY ELISE (OTA/L)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:ELISE
Last Name:COX
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 RICHARDSON WAY
Mailing Address - Street 2:
Mailing Address - City:MAYNARDVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37807-3803
Mailing Address - Country:US
Mailing Address - Phone:865-992-5816
Mailing Address - Fax:
Practice Address - Street 1:215 RICHARDSON WAY
Practice Address - Street 2:
Practice Address - City:MAYNARDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37807-3803
Practice Address - Country:US
Practice Address - Phone:865-992-5816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1920224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant