Provider Demographics
NPI:1952380339
Name:PETTIT, MARIAH (MED,OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MARIAH
Middle Name:
Last Name:PETTIT
Suffix:
Gender:F
Credentials:MED,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1173 ROCK SPRINGS RD STE 105
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-8414
Mailing Address - Country:US
Mailing Address - Phone:615-220-5796
Mailing Address - Fax:
Practice Address - Street 1:1173 ROCK SPRINGS RD STE 105
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-8414
Practice Address - Country:US
Practice Address - Phone:615-220-5796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC005816L225XP0200X
MEOT94225XP0200X
TN5666225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics