Provider Demographics
NPI:1356788566
Name:MIDDEKER, MONICA LYNN (OTR/L)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:LYNN
Last Name:MIDDEKER
Suffix:
Gender:F
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 1:2417 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-7041
Mailing Address - Country:US
Mailing Address - Phone:585-750-5231
Mailing Address - Fax:
Practice Address - Street 1:136 CANTON HOLLOW RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-3003
Practice Address - Country:US
Practice Address - Phone:865-984-6561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3199224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant