Healthcare Provider Details

I. General information

NPI: 1891104774
Provider Name (Legal Business Name): WHITNEY HODGE OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

711 AVIGNON DR
RIDGELAND MS
39157-5120
US

IV. Provider business mailing address

711 AVIGNON DR
RIDGELAND MS
39157-5120
US

V. Phone/Fax

Practice location:
  • Phone: 601-605-6777
  • Fax: 601-607-1415
Mailing address:
  • Phone: 601-605-6777
  • Fax: 601-607-1415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT2972
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: