Healthcare Provider Details

I. General information

NPI: 1467537449
Provider Name (Legal Business Name): JULIE M FALLA OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3688 VETERANS MEMORIAL DR SUITE 300
HATTIESBURG MS
39401-8246
US

IV. Provider business mailing address

3688 VETERANS MEMORIAL DR SUITE 300
HATTIESBURG MS
39401-8246
US

V. Phone/Fax

Practice location:
  • Phone: 601-543-0221
  • Fax: 601-543-0201
Mailing address:
  • Phone: 601-543-0221
  • Fax: 601-543-0201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOT0851
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: