Healthcare Provider Details

I. General information

NPI: 1578071122
Provider Name (Legal Business Name): INSIDE OUT OCCUPATIONAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 01/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 W FRONT ST
IUKA MS
38852-2325
US

IV. Provider business mailing address

PO BOX 993
IUKA MS
38852-0993
US

V. Phone/Fax

Practice location:
  • Phone: 601-218-5703
  • Fax:
Mailing address:
  • Phone: 601-218-5703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateMS

VIII. Authorized Official

Name: BETTY CHILES
Title or Position: CREDENTIALING SPECALIST
Credential:
Phone: 601-618-5120