Healthcare Provider Details

I. General information

NPI: 1770428435
Provider Name (Legal Business Name): PRESLEIGH BOX COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 E MAIN ST
SENATOBIA MS
38668-2140
US

IV. Provider business mailing address

453 JJ RANCH RD
SENATOBIA MS
38668-3538
US

V. Phone/Fax

Practice location:
  • Phone: 662-292-1024
  • Fax: 662-796-4740
Mailing address:
  • Phone: 662-292-1024
  • Fax: 662-796-4740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA-4086
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: