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General NPI Number Information
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NPI Number | 1174427827
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Entity Type | Organization
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Legal Business Name | THRIVE PEDIATRIC OCCUPATIONAL THERAPY
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Dates
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Enumeration Date | 10/06/2026
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Last Update Date | 10/06/2026
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Provider Practice Location Address
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Address Line | 22 JIL MARIE CIR
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City | VICKSBURG
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State | MS
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Zip | 39183-8739
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Country | US
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Telephone | 601-415-5759
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Fax |
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Provider Business Mailing Address
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Address Line | 22 JIL MARIE CIR
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City | VICKSBURG
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State | MS
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Zip | 39183-8739
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Country | US
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Telephone | 601-415-5759
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MRS. MARY AMBER BREWER
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Credential | OTR/L
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Telephone | 601-415-5759
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State | NULL
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