Basic Information
| Provider Information | |||||||||
| NPI: | 1366117632 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHOWMAN | ||||||||
| FirstName: | RICKY | ||||||||
| MiddleName: | DALE | ||||||||
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| NameSuffix: | JR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 214 TUCKER HOLLOW RD | ||||||||
| Address2: | |||||||||
| City: | FALL BRANCH | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376562040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232920251 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2830 HIGHWAY 394 | ||||||||
| Address2: | |||||||||
| City: | BLOUNTVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376175577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232746191 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2021 | ||||||||
| LastUpdateDate: | 08/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 3617 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.