Provider Demographics
NPI:1801006184
Name:FLETCHALL, SANDRA K (OTRL,CHT,FAOTA,MPA)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:K
Last Name:FLETCHALL
Suffix:
Gender:F
Credentials:OTRL,CHT,FAOTA,MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7180 HELENE DR
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-4753
Mailing Address - Country:US
Mailing Address - Phone:901-872-6025
Mailing Address - Fax:901-873-0798
Practice Address - Street 1:748 WALNUT KNOLL LN
Practice Address - Street 2:SUITE 1
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-3110
Practice Address - Country:US
Practice Address - Phone:901-507-4780
Practice Address - Fax:901-507-4786
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT0000000002225X00000X
9105000371225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand