Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT2271 | MS |
NPI | 1093088072 |
---|---|
Provider Name | Laura Ashley |
First Address | Byram, MS 39272-9776 |
Second Address | Jackson, MS 39202-1113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2012 |
Last Update Date | 21/02/2012 |