Provider Demographics
NPI:1528728193
Name:TINNER, LASHONNA DENISE
Entity type:Individual
Prefix:
First Name:LASHONNA
Middle Name:DENISE
Last Name:TINNER
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 1:4 1 3 0 CHERYL DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116
Mailing Address - Country:US
Mailing Address - Phone:901-215-8217
Mailing Address - Fax:
Practice Address - Street 1:6500 KIRBY GATE BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-2673
Practice Address - Country:US
Practice Address - Phone:901-752-0772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-23
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN455154224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1528728193Medicaid
TN111111111111OtherTHERAPY