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General NPI Number Information
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NPI Number | 1023250594
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Entity Type | Individual
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Provider Name | TARAH AURELIA MANNERY OTR/L, MS
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Gender | Female
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Dates
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Enumeration Date | 03/30/2009
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 731 AVIGNON DR STE 4
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City | RIDGELAND
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State | MS
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Zip | 39157
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Country | US
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Telephone | 601-300-2624
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Fax | 601-510-3512
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Provider Business Mailing Address
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Address Line | 6208 FERNCREEK DR
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City | JACKSON
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State | MS
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Zip | 39211-2003
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Country | US
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Telephone | 601-259-8517
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 015655
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT1714
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License Number State | MS
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