Provider Demographics
NPI:1881899748
Name:OTERO, TANASI MICHELLE (MA, CCC, SLP)
Entity type:Individual
Prefix:MRS
First Name:TANASI
Middle Name:MICHELLE
Last Name:OTERO
Suffix:
Gender:F
Credentials:MA, CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 SEVEN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3859
Mailing Address - Country:US
Mailing Address - Phone:615-730-7845
Mailing Address - Fax:
Practice Address - Street 1:136 SEVEN SPRINGS DR
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3859
Practice Address - Country:US
Practice Address - Phone:615-730-7845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3596235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist