Healthcare Provider Details

I. General information

NPI: 1750885588
Provider Name (Legal Business Name): OPTIMUM OCCUPATIONAL THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2018
Last Update Date: 10/09/2022
Certification Date: 10/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 HIGHWAY 82 W
GREENWOOD MS
38930-5028
US

IV. Provider business mailing address

PO BOX 573
BELZONI MS
39038-0573
US

V. Phone/Fax

Practice location:
  • Phone: 662-455-0030
  • Fax: 662-247-1489
Mailing address:
  • Phone: 662-455-0030
  • Fax: 662-247-1489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XL0004X
TaxonomyLow Vision Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MISS SHIRLEY BLANTON
Title or Position: MEMBER-MANAGER, CEO
Credential: MOT, OTR/L, SCLV
Phone: 662-455-0030