Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT3833 | MS |
NPI | 1043812225 |
---|---|
Provider Name | Samantha C Pierce |
First Address | Vancleave, MS 39565-6771 |
Second Address | Gulfport, MS 39503-2637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2020 |
Last Update Date | 12/11/2020 |