Healthcare Provider Details

I. General information

NPI: 1346569076
Provider Name (Legal Business Name): ANNETTE MCDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4109 HIGHWAY 98 W
SUMMIT MS
39666-9132
US

IV. Provider business mailing address

1007 GLENWOOD DR
WEST MONROE LA
71291-5501
US

V. Phone/Fax

Practice location:
  • Phone: 601-276-3900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberZ20516
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: