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General NPI Number Information
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NPI Number | 1568874592
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Entity Type | Individual
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Provider Name | STEPHANIE MIMMS OTR/L
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Gender | Female
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Dates
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Enumeration Date | 05/26/2014
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 1102 HIBISCUS ST
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City | ATLANTIC BEACH
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State | FL
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Zip | 32233-2657
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Country | US
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Telephone | 662-497-0485
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Fax |
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Provider Business Mailing Address
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Address Line | 1052 WHITWORTH ST
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City | JACKSON
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State | MS
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Zip | 39202-2745
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Country | US
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Telephone | 662-497-0485
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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 | OT24610
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License Number State | FL
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