Provider Demographics
NPI:1053538934
Name:STECKLINE, MARY B (COTA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:B
Last Name:STECKLINE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4123 GOLF VIEW CV
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-5195
Mailing Address - Country:US
Mailing Address - Phone:901-382-1640
Mailing Address - Fax:
Practice Address - Street 1:2805 CHARLES BRYAN RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-4756
Practice Address - Country:US
Practice Address - Phone:901-388-4775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000737313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility