Healthcare Provider Details

I. General information

NPI: 1104225655
Provider Name (Legal Business Name): JESSICA SINGLETON COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA MYRICK OTR/L

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 DOGWOOD PL
FLOWOOD MS
39232-8623
US

IV. Provider business mailing address

411 DOGWOOD PL
FLOWOOD MS
39232-8623
US

V. Phone/Fax

Practice location:
  • Phone: 601-832-4918
  • Fax:
Mailing address:
  • Phone: 601-832-4918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT3920
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: