Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT1291 | MS |
NPI | 1003009481 |
---|---|
Provider Name | Barbara A Wiggins |
First Address | Ridgeland, MS 39158 |
Second Address | Jackson, MS 39211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2007 |
Last Update Date | 20/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09014160 | (05) | MS |