Healthcare Provider Details

I. General information

NPI: 1750859237
Provider Name (Legal Business Name): REBECCA MCWHONER SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2018
Last Update Date: 11/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 ENTERPRISE DR
BILOXI MS
39531-4039
US

IV. Provider business mailing address

711 AVIGNON DR
RIDGELAND MS
39157-5120
US

V. Phone/Fax

Practice location:
  • Phone: 228-385-3385
  • Fax: 601-790-6416
Mailing address:
  • Phone: 601-605-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT2136
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: