Provider Demographics
NPI:1871335505
Name:WARDELL, GRACE (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:WARDELL
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:HAUB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:808 SUMMERDALE DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-5054
Mailing Address - Country:US
Mailing Address - Phone:865-566-6982
Mailing Address - Fax:
Practice Address - Street 1:9649 WESTLAND DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-5113
Practice Address - Country:US
Practice Address - Phone:865-223-6422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8005225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist