Provider Demographics
NPI:1851289755
Name:RUTHERFORD, SAMUEL TATE (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:TATE
Last Name:RUTHERFORD
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8041 GOLD BELL ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-5069
Mailing Address - Country:US
Mailing Address - Phone:423-258-8585
Mailing Address - Fax:
Practice Address - Street 1:8041 GOLD BELL ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-5069
Practice Address - Country:US
Practice Address - Phone:423-258-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7776225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist