Provider Demographics
NPI:1881255354
Name:FAIN, TERESA SUZETTE (COTA/L)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:SUZETTE
Last Name:FAIN
Suffix:
Gender:F
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 1:251 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874-6217
Mailing Address - Country:US
Mailing Address - Phone:423-519-7495
Mailing Address - Fax:423-337-6834
Practice Address - Street 1:251 MEADOW LN
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TN
Practice Address - Zip Code:37874-6217
Practice Address - Country:US
Practice Address - Phone:423-519-7495
Practice Address - Fax:423-337-6834
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000002531224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant