MEDICARE: ROSA M VERNEUILLE O.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT1050	MS

General Provider Information

NPI Number	:	1346439684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSA M VERNEUILLE O.T.

Provider Business Mailing Address
First Line	:	2416 HIGHWAY 45 N
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39705-1320
Country	:	US
Telephone Number	:	662-327-6705
Fax Number	:	662-327-6760

Provider Business Practice Location Address
First Line	:	1201 HIGHWAY 49 S
Second Line	:	SUITE 2
City	:	RICHLAND
State	:	MS
Zip	:	39218-9425
Country	:	US
Telephone Number	:	769-233-8844
Fax Number	:	769-251-1825

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	12/02/2015

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