Healthcare Provider Details

I. General information

NPI: 1508103474
Provider Name (Legal Business Name): BRITTANY CHANDLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 12/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4607 LINDBERGH DR
JACKSON MS
39209-3855
US

IV. Provider business mailing address

711 AVIGNON DR
RIDGELAND MS
39157-5120
US

V. Phone/Fax

Practice location:
  • Phone: 601-353-9934
  • Fax:
Mailing address:
  • Phone: 601-605-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberTA2556
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3606
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: