Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT1805 | MS |
NPI | 1285905679 |
---|---|
Provider Name | Joanna Kidder |
First Address | Natchez, MS 39120-4782 |
Second Address | Natchez, MS 39120-4782 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2012 |
Last Update Date | 03/01/2020 |