Healthcare Provider Details

I. General information

NPI: 1184153843
Provider Name (Legal Business Name): TORRE WELLS OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 06/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 DENNY AVE
PASCAGOULA MS
39581-5301
US

IV. Provider business mailing address

251 JOHNSTON ST SE STE 300
DECATUR AL
35601-2515
US

V. Phone/Fax

Practice location:
  • Phone: 228-471-1521
  • Fax: 228-471-1548
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT2065
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: