Provider Demographics
NPI:1205304110
Name:NOVILLA, KAROLINE LANCASTER (COTA)
Entity type:Individual
Prefix:
First Name:KAROLINE
Middle Name:LANCASTER
Last Name:NOVILLA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:KAROLINE
Other - Middle Name:KIM
Other - Last Name:MANGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-586-4810
Mailing Address - Fax:423-586-4811
Practice Address - Street 1:2817 W ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3216
Practice Address - Country:US
Practice Address - Phone:423-586-4810
Practice Address - Fax:423-586-4811
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3086224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant