Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT2849 | MS |
NPI | 1336574771 |
---|---|
Provider Name | Elissa Rodgers |
First Address | Ridgeland, MS 39157-5120 |
Second Address | Ridgeland, MS 39157-5120 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2013 |
Last Update Date | 04/09/2013 |