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General NPI Number Information
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NPI Number | 1578071122
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Entity Type | Organization
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Legal Business Name | INSIDE OUT OCCUPATIONAL THERAPY
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Dates
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Enumeration Date | 01/17/2018
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Last Update Date | 01/17/2018
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Provider Practice Location Address
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Address Line | 106 W FRONT ST
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City | IUKA
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State | MS
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Zip | 38852-2325
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Country | US
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Telephone | 601-218-5703
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 993
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City | IUKA
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State | MS
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Zip | 38852-0993
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Country | US
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Telephone | 601-218-5703
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECALIST
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Name | BETTY CHILES
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Credential |
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Telephone | 601-618-5120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State | MS
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