Healthcare Provider Details

I. General information

NPI: 1326422288
Provider Name (Legal Business Name): MARY AMBER HOLLINGSWORTH OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W JACKSON ST SUITE #2
RIDGELAND MS
39157-2355
US

IV. Provider business mailing address

207 W JACKSON ST SUITE #2
RIDGELAND MS
39157-2355
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-0859
  • Fax: 601-362-0870
Mailing address:
  • Phone: 601-362-0859
  • Fax: 601-362-0870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT3091
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: