Basic Information
| Provider Information | |||||||||
| NPI: | 1275803009 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOPPENWORTH | ||||||||
| FirstName: | BEVERLY | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | C.O.T.A./L. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1310 RIPLEY DR | ||||||||
| Address2: | |||||||||
| City: | MARYVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378039204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654068296 | ||||||||
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| Practice Location | |||||||||
| Address1: | 120 CAVETTE HILL LN | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379346673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8657774000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2012 | ||||||||
| LastUpdateDate: | 01/10/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 0000000584 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.