Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XL0004X | Low Vision | OT1121 | MS |
NPI | 1225531486 |
---|---|
Provider Name | Miss Shirley Ann Blanton |
First Address | Belzoni, MS 39038-3427 |
Second Address | Belzoni, MS 39038-3427 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2018 |
Last Update Date | 14/03/2018 |