Provider Demographics
NPI:1629334578
Name:SANDS, KATHRYN CHASE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:CHASE
Last Name:SANDS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 OLD SMITHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-6805
Mailing Address - Country:US
Mailing Address - Phone:931-473-8431
Mailing Address - Fax:
Practice Address - Street 1:928 OLD SMITHVILLE RD
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-6805
Practice Address - Country:US
Practice Address - Phone:931-473-8431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4535225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN225X00000XMedicare Oscar/Certification