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General NPI Number Information
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NPI Number | 1033682950
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Entity Type | Individual
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Provider Name | COZETTA MARIE MCMILLIAN OTD, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 01/03/2019
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Last Update Date | 01/03/2019
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Provider Practice Location Address
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Address Line | 107 MEADOW LN
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City | JACKSON
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State | MS
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Zip | 39212-3525
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Country | US
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Telephone | 601-209-6453
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Fax |
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Provider Business Mailing Address
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Address Line | 107 MEADOW LN
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City | JACKSON
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State | MS
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Zip | 39212-3525
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Country | US
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Telephone |
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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 | OT19612
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License Number State | FL
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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 | 4575
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License Number State | SC
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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 | 13451
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 4779
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License Number State | AL
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Taxonomy #5
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 310303
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License Number State | LA
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