Healthcare Provider Details

I. General information

NPI: 1376251876
Provider Name (Legal Business Name): JESSICA FERRELL OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9993 HIGHWAY 501
FOREST MS
39074-9424
US

IV. Provider business mailing address

921 W BEACON ST
PHILADELPHIA MS
39350-3229
US

V. Phone/Fax

Practice location:
  • Phone: 662-207-7497
  • Fax:
Mailing address:
  • Phone: 601-650-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-3499
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: