Healthcare Provider Details

I. General information

NPI: 1629448899
Provider Name (Legal Business Name): CAITLIN ADAMS BURNETT MOTR/L, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2015
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST STE 210
JACKSON MS
39202-2000
US

IV. Provider business mailing address

302 HUNTERS CRST
RIDGELAND MS
39157-8711
US

V. Phone/Fax

Practice location:
  • Phone: 601-714-3202
  • Fax: 601-714-3416
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT3103
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: