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General NPI Number Information
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NPI Number | 1225926272
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Entity Type | Organization
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Legal Business Name | AUTUMN TAMOR
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Dates
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Enumeration Date | 06/26/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 116 MARKETRIDGE DR
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City | RIDGELAND
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State | MS
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Zip | 39157-6009
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Country | US
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Telephone | 601-345-1784
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Fax |
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Provider Business Mailing Address
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Address Line | 1229 POPLAR BLVD
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City | JACKSON
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State | MS
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Zip | 39202-2110
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Country | US
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Telephone | 601-345-1784
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AUTUMN TAMOR
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Credential | OT
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Telephone | 601-345-1784
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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 |
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