Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 3713 | MS |
NPI | 1003466871 |
---|---|
Provider Name | Jessica Carter |
First Address | Biloxi, MS 39532-4633 |
Second Address | Ocean Springs, MS 39564-2648 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2019 |
Last Update Date | 13/09/2019 |