Healthcare Provider Details

I. General information

NPI: 1124316914
Provider Name (Legal Business Name): TYRICE CARTWRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7579 WISTERIA DR
OLIVE BRANCH MS
38654-6982
US

IV. Provider business mailing address

7579 WISTERIA DR
OLIVE BRANCH MS
38654-6982
US

V. Phone/Fax

Practice location:
  • Phone: 615-717-7471
  • Fax:
Mailing address:
  • Phone: 615-717-7471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number4353
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number2819
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number2432
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: