Provider Demographics
NPI:1629898143
Name:SMALL, ERIC NORMAN (OTR/L, PTA)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:NORMAN
Last Name:SMALL
Suffix:
Gender:M
Credentials:OTR/L, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6317 CELTIC DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37416-1404
Mailing Address - Country:US
Mailing Address - Phone:423-503-5737
Mailing Address - Fax:
Practice Address - Street 1:1400 MCCALLIE AVE STE 100
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2927
Practice Address - Country:US
Practice Address - Phone:423-531-6961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5513225200000X
TN8158225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant