Provider Demographics
NPI:1952773988
Name:GUPTON, ANN (COTA/L, CLT)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:GUPTON
Suffix:
Gender:F
Credentials:COTA/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 POPLAR ACRES RD
Mailing Address - Street 2:
Mailing Address - City:PIPERTON
Mailing Address - State:TN
Mailing Address - Zip Code:38017-5132
Mailing Address - Country:US
Mailing Address - Phone:865-776-1832
Mailing Address - Fax:
Practice Address - Street 1:210 POPLAR ACRES RD
Practice Address - Street 2:
Practice Address - City:PIPERTON
Practice Address - State:TN
Practice Address - Zip Code:38017-5132
Practice Address - Country:US
Practice Address - Phone:865-776-1832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN257224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant