Provider Demographics
NPI:1639814171
Name:TATLONGHARI, JEFF (OT)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:TATLONGHARI
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 SADDLE DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-1903
Mailing Address - Country:US
Mailing Address - Phone:407-222-8918
Mailing Address - Fax:
Practice Address - Street 1:2075 N GERMANTOWN PKWY STE 108
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-1730
Practice Address - Country:US
Practice Address - Phone:407-222-8918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000007116225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist