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General NPI Number Information
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NPI Number | 1811505746
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Entity Type | Individual
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Provider Name | FELICIA MUKESH KAPOOR
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Gender | Female
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Dates
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Enumeration Date | 07/16/2020
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Last Update Date | 07/16/2020
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Provider Practice Location Address
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Address Line | 7579 WISTERIA DR
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-6982
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Country | US
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Telephone | 901-468-3667
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 COLONIAL DR
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City | WEST MEMPHIS
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State | AR
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Zip | 72301-2496
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Country | US
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Telephone | 870-822-2026
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 3423
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License Number State | TN
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