Healthcare Provider Details

I. General information

NPI: 1013585660
Provider Name (Legal Business Name): BLAIR MCGEE OT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 TURTLE LN
BRANDON MS
39047-5087
US

IV. Provider business mailing address

512 TURTLE LN
BRANDON MS
39047-5087
US

V. Phone/Fax

Practice location:
  • Phone: 662-207-1090
  • Fax: 601-510-9861
Mailing address:
  • Phone: 662-207-1090
  • Fax: 601-510-9861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: BLAIR WEBB MCGEE
Title or Position: OCCUPATIONAL THERAPIST
Credential: MOTR/L
Phone: 662-207-1090