Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT2573 | MS |
N | 225XG0600X | Occupational Therapist - Gerontology | OT2573 | MS |
NPI | 1013306729 |
---|---|
Provider Name | Mrs. Constance Hope Marshall |
First Address | Buckatunna, MS 39322-9630 |
Second Address | Laurel, MS 39440-4706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2015 |
Last Update Date | 19/01/2015 |