Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist |
NPI | 1003130246 |
---|---|
Provider Name | Jessica Kopf Cornett |
First Address | Summit, MS 39666-9132 |
Second Address | Hattiesburg, MS 39401-7230 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2010 |
Last Update Date | 04/08/2011 |