Provider Demographics
NPI:1578090528
Name:CHAN, CAROL (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 PROFESSIONAL PLZ STE 101
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1534
Mailing Address - Country:US
Mailing Address - Phone:901-328-2110
Mailing Address - Fax:901-590-3999
Practice Address - Street 1:3180 PROFESSIONAL PLZ STE 101
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1534
Practice Address - Country:US
Practice Address - Phone:901-328-2110
Practice Address - Fax:901-590-3999
Is Sole Proprietor?:No
Enumeration Date:2017-05-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4801225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist