MEDICARE: MISS KAELA MARIE JONES OTD, OTR/L

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	225XP0019X	Physical Rehabilitation Occupational Therapist	OT3959	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OT3959	OTHER	MS	N/A

General Provider Information

NPI Number	:	1669100202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KAELA MARIE JONES OTD, OTR/L

Provider Business Mailing Address
First Line	:	316 RIDGE PARK DR
Second Line	:
City	:	RAYMOND
State	:	MS
Zip	:	39154-7511
Country	:	US
Telephone Number	:	601-473-6915
Fax Number	:

Provider Business Practice Location Address
First Line	:	806 W GEORGETOWN ST
Second Line	:
City	:	CRYSTAL SPRINGS
State	:	MS
Zip	:	39059-9453
Country	:	US
Telephone Number	:	601-473-6915
Fax Number	:

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

Provider Enumeration Date	:	08/11/2022
Last Update Date	:	08/11/2022

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