Healthcare Provider Details

I. General information

NPI: 1023719671
Provider Name (Legal Business Name): BRITTANY ALLIE MCILWAIN ATR-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14319 SANTA FE DR
OLIVE BRANCH MS
38654-6346
US

IV. Provider business mailing address

14319 SANTA FE DR
OLIVE BRANCH MS
38654-6346
US

V. Phone/Fax

Practice location:
  • Phone: 901-455-7190
  • Fax:
Mailing address:
  • Phone: 901-455-7190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: