Provider Demographics
NPI:1013329358
Name:TATE, JOHN PARKER (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PARKER
Last Name:TATE
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 OAK ST EXT
Mailing Address - Street 2:SUITE 145
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-3510
Mailing Address - Country:US
Mailing Address - Phone:828-245-5003
Mailing Address - Fax:828-245-5798
Practice Address - Street 1:247 OAK ST
Practice Address - Street 2:SUITE 145
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-3510
Practice Address - Country:US
Practice Address - Phone:828-245-5003
Practice Address - Fax:828-245-5798
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9419225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist