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NPI Code Detail

MEDICARE: CECELIA CLAIRE PRENTISS OT

MEDICARE: CECELIA CLAIRE PRENTISS OT
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
1225XP0200XPediatric Occupational Therapist

General Provider Information

NPI Number : 1417719980
Entity Type Code : Individual
Provider Name (Legal Business Name) : CECELIA CLAIRE PRENTISS OT
Provider Business Mailing Address
First Line : 4214 BIENVILLE BLVD
Second Line :
City : OCEAN SPRINGS
State : MS
Zip : 39564-5975
Country : US
Telephone Number : 228-300-2857
Fax Number :
Provider Business Practice Location Address
First Line : 4214 BIENVILLE BLVD
Second Line :
City : OCEAN SPRINGS
State : MS
Zip : 39564-5975
Country : US
Telephone Number : 228-300-2857
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2024
Last Update Date : 01/29/2024

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Directions to “ CECELIA CLAIRE PRENTISS OT” Practice Location

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