Provider Demographics
NPI:1134630395
Name:COLLETTI, MEGAN (OCCUPATIONAL THERAPI)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:COLLETTI
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 E WEISGARBER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2677
Mailing Address - Country:US
Mailing Address - Phone:865-579-0552
Mailing Address - Fax:865-579-1154
Practice Address - Street 1:1128 E WEISGARBER RD STE 100
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2677
Practice Address - Country:US
Practice Address - Phone:865-579-0552
Practice Address - Fax:865-579-1154
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
TN5764225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist