Healthcare Provider Details

I. General information

NPI: 1578928354
Provider Name (Legal Business Name): TUPELO PUBLIC SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S 7TH AVE
TUPELO OK
74572-7201
US

IV. Provider business mailing address

200 S 7TH AVE
TUPELO OK
74572-7201
US

V. Phone/Fax

Practice location:
  • Phone: 580-845-2460
  • Fax: 580-845-2565
Mailing address:
  • Phone: 580-845-2460
  • Fax: 580-845-2565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JERRY ROMINES
Title or Position: SUPERINTENDENT
Credential:
Phone: 580-845-2460