Healthcare Provider Details

I. General information

NPI: 1114334414
Provider Name (Legal Business Name): DAVID PARKER GREGORY OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HIGHWAY 15 S
PONTOTOC MS
38863-2628
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 662-586-2444
  • Fax: 662-489-8970
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT2962
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number5016
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: