Healthcare Provider Details

I. General information

NPI: 1437072121
Provider Name (Legal Business Name): KELSEA MILLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 KENDALL AVE
MCCOMB MS
39648-2854
US

IV. Provider business mailing address

318 KENDALL AVE
MCCOMB MS
39648-2854
US

V. Phone/Fax

Practice location:
  • Phone: 601-600-2633
  • Fax: 601-385-1626
Mailing address:
  • Phone: 601-600-2633
  • Fax: 601-385-1626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-4363
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: