Provider Demographics
NPI:1689334195
Name:FRASER, MARY CAROLINE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CAROLINE
Last Name:FRASER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 GENERAL GEORGE PATTON DR STE 202B
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6429
Mailing Address - Country:US
Mailing Address - Phone:615-377-1623
Mailing Address - Fax:
Practice Address - Street 1:1880 GENERAL GEORGE PATTON DR STE 202B
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6429
Practice Address - Country:US
Practice Address - Phone:615-377-1623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6775225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics