Provider Demographics
NPI:1881019859
Name:HENDERSON, RICHARD M JR
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:M
Last Name:HENDERSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5321 BEVERLY PARK CIR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-9253
Mailing Address - Country:US
Mailing Address - Phone:865-687-1321
Mailing Address - Fax:
Practice Address - Street 1:5321 BEVERLY PARK CIR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918
Practice Address - Country:US
Practice Address - Phone:865-687-1321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-27
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN225X00000X
TN4965225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist