Provider Demographics
NPI:1821686254
Name:MCALISTER, MARTHA LANE
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:LANE
Last Name:MCALISTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 FERNSPRING CV
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3116
Mailing Address - Country:US
Mailing Address - Phone:479-236-5546
Mailing Address - Fax:
Practice Address - Street 1:1836 FERNSPRING CV
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3116
Practice Address - Country:US
Practice Address - Phone:479-236-5546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6684225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist