Healthcare Provider Details

I. General information

NPI: 1518257609
Provider Name (Legal Business Name): CHESTER ALLEN DREWREY JR. OT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 S LAMAR BLVD
OXFORD MS
38655
US

IV. Provider business mailing address

1050 RIVER OAKS DR SUITE 110
FLOWOOD MS
39232-9564
US

V. Phone/Fax

Practice location:
  • Phone: 662-234-8559
  • Fax: 662-234-7923
Mailing address:
  • Phone: 601-366-3400
  • Fax: 601-366-3439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT2542
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: