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General NPI Number Information
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NPI Number | 1417432816
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Entity Type | Individual
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Provider Name | PATRICK JAY MITCHELL OTR/L
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Gender | Male
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Dates
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Enumeration Date | 10/01/2018
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Last Update Date | 10/01/2018
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Provider Practice Location Address
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Address Line | 1199 OCEAN SPRINGS RD
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-3421
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Country | US
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Telephone | 228-875-9363
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Fax |
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Provider Business Mailing Address
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Address Line | 6 LIZA CT
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City | DEFIANCE
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State | MO
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Zip | 63341-1357
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Country | US
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Telephone | 314-779-8668
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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 | OT3482
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License Number State | MS
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