Healthcare Provider Details

I. General information

NPI: 1073145272
Provider Name (Legal Business Name): HEIDI DRYDEN MOLAISON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 N HILL DR
CARRIERE MS
39426-8129
US

IV. Provider business mailing address

141 N HILL DR
CARRIERE MS
39426-8129
US

V. Phone/Fax

Practice location:
  • Phone: 601-215-3267
  • Fax: 601-255-8626
Mailing address:
  • Phone: 601-215-3267
  • Fax: 601-255-8626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-331
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: