Provider Demographics
NPI:1902437478
Name:RICH, ETTA RENEE
Entity Type:Individual
Prefix:
First Name:ETTA
Middle Name:RENEE
Last Name:RICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:BEAN STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37708-0608
Mailing Address - Country:US
Mailing Address - Phone:423-375-8907
Mailing Address - Fax:423-317-7773
Practice Address - Street 1:900 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-2448
Practice Address - Country:US
Practice Address - Phone:423-500-5600
Practice Address - Fax:423-317-7773
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist