Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT2774 | MS |
N | 225XE0001X | Environmental Modification | OT2774 | MS |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT2774 | MS |
N | 225XR0403X | Driving and Community Mobility | OT2774 | MS |
NPI | 1467956508 |
---|---|
Provider Name | Jimmy Eric Knox |
First Address | Mississippi State, MS 39762 |
Second Address | Mississippi State, MI 39762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2018 |
Last Update Date | 22/03/2018 |