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General NPI Number Information
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NPI Number | 1326496621
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Entity Type | Individual
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Provider Name | ANGELA ESTES
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Gender | Female
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 05/26/2016
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Provider Practice Location Address
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Address Line | COUNTY ROAD 1279 HOUSE#197
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City | TUPELO
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State | MS
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Zip | 38804
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Country | US
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Telephone | 662-610-6124
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 267
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City | MOOREVILLE
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State | MS
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Zip | 38857-0267
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Country | US
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Telephone | 662-610-6124
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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 | 225XG0600X
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Taxonomy Name | Gerontology Occupational Therapist
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License Number | TA0114
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License Number State | WI
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