Provider Demographics
NPI:1578391595
Name:PICKETT, BRUCE E (COTA/ L)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:E
Last Name:PICKETT
Suffix:
Gender:M
Credentials:COTA/ L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 WALDEN LEGACY WAY APT 436
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-4652
Mailing Address - Country:US
Mailing Address - Phone:941-720-6075
Mailing Address - Fax:
Practice Address - Street 1:3916 BOYDS BRIDGE PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37914-6233
Practice Address - Country:US
Practice Address - Phone:865-524-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4104224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant