Healthcare Provider Details

I. General information

NPI: 1174427827
Provider Name (Legal Business Name): THRIVE PEDIATRIC OCCUPATIONAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 JIL MARIE CIR
VICKSBURG MS
39183-8739
US

IV. Provider business mailing address

22 JIL MARIE CIR
VICKSBURG MS
39183-8739
US

V. Phone/Fax

Practice location:
  • Phone: 601-415-5759
  • Fax:
Mailing address:
  • Phone: 601-415-5759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. MARY AMBER BREWER
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 601-415-5759