Healthcare Provider Details

I. General information

NPI: 1356459101
Provider Name (Legal Business Name): KATHY G ARMSTRONG O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 06/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 SUNSET DR SUITE F
GRENADA MS
38901-4086
US

IV. Provider business mailing address

1300 SUNSET DR SUITE F
GRENADA MS
38901-4086
US

V. Phone/Fax

Practice location:
  • Phone: 662-226-5747
  • Fax: 662-226-5622
Mailing address:
  • Phone: 662-226-5747
  • Fax: 662-226-5622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT008
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: