Provider Demographics
NPI:1801402797
Name:VANTREASE, CAROLINE HARBER (MOT)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:HARBER
Last Name:VANTREASE
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 PEMBERTON DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-7652
Mailing Address - Country:US
Mailing Address - Phone:731-394-0509
Mailing Address - Fax:
Practice Address - Street 1:3425 KNIGHT DR
Practice Address - Street 2:
Practice Address - City:WHITES CREEK
Practice Address - State:TN
Practice Address - Zip Code:37189-9189
Practice Address - Country:US
Practice Address - Phone:615-876-2754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT4649225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist