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General NPI Number Information
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NPI Number | 1689481301
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Entity Type | Individual
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Provider Name | HALEY M COUCH OT
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Gender | Female
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 1301 W GOVERNMENT ST
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City | BRANDON
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State | MS
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Zip | 39042-3196
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Country | US
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Telephone | 601-724-8886
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Fax |
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Provider Business Mailing Address
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Address Line | 921 W BEACON ST
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City | PHILADELPHIA
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State | MS
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Zip | 39350-3229
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Country | US
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Telephone | 601-650-0002
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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 | OT4194
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License Number State | MS
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