Basic Information
| Provider Information | |||||||||
| NPI: | 1417411877 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KNORR | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1012 WOODDALE CHURCH RD | ||||||||
| Address2: | |||||||||
| City: | STRAWBERRY PLAINS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378711454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236537189 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2304 E LAMAR ALEXANDER PKWY | ||||||||
| Address2: | |||||||||
| City: | MARYVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378045316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659806000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2019 | ||||||||
| LastUpdateDate: | 01/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 423313 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.