MEDICARE: SOUTHEASTERN ASSISTIVE TECHNOLOGY SOLUTIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT3204	MS
2	225100000X	Physical Therapist	PTH4728	AL
3	225100000X	Physical Therapist	PT06987R	LA
4	225X00000X	Occupational Therapist	OT0488	MS
5	225100000X	Physical Therapist	PT7497	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568555803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEASTERN ASSISTIVE TECHNOLOGY SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	521 PELAHATCHIE SHORE DR
Second Line	:
City	:	BRANDON
State	:	MS
Zip	:	39047-6282
Country	:	US
Telephone Number	:	601-613-7328
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 PELAHATCHIE SHORE DR
Second Line	:
City	:	BRANDON
State	:	MS
Zip	:	39047-6282
Country	:	US
Telephone Number	:	601-613-7328
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. KITTY J STOGNER
Credential	:	PT, ATP
Telephone Number	:	601-613-7328

Provider Enumeration Date	:	10/01/2006
Last Update Date	:	09/11/2025

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Directions to “SOUTHEASTERN ASSISTIVE TECHNOLOGY SOLUTIONS, LLC ” Practice Location

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