Healthcare Provider Details

I. General information

NPI: 1295263408
Provider Name (Legal Business Name): RANDEE SCHEREE BUCHANAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2017
Last Update Date: 06/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W JACKSON ST STE 2
RIDGELAND MS
39157-2355
US

IV. Provider business mailing address

1047 PARKWOOD PL
JACKSON MS
39206-6155
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-0859
  • Fax:
Mailing address:
  • Phone: 615-604-7596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT3322
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: