Provider Demographics
NPI:1992391239
Name:PETERSON, CINDY DUGGAN (COTA/L)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:DUGGAN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 LAKE TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-5122
Mailing Address - Country:US
Mailing Address - Phone:615-573-5569
Mailing Address - Fax:
Practice Address - Street 1:248 LAKE TERRACE DR
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-5122
Practice Address - Country:US
Practice Address - Phone:615-573-5569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3466224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant