Provider Demographics
NPI:1932372828
Name:POYTHRESS, AUBREY (MSOT)
Entity Type:Individual
Prefix:
First Name:AUBREY
Middle Name:
Last Name:POYTHRESS
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2264 MONTHEMER CV
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-7459
Mailing Address - Country:US
Mailing Address - Phone:615-866-7652
Mailing Address - Fax:
Practice Address - Street 1:2264 MONTHEMER CV
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-7459
Practice Address - Country:US
Practice Address - Phone:615-866-7652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4112225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics