MEDICARE: MR. TERRY MARK WINSTEAD OTR

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	OT0928	MS

General Provider Information

NPI Number	:	1942394648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TERRY MARK WINSTEAD OTR

Provider Business Mailing Address
First Line	:	1058 HOLLAND AVE
Second Line	:
City	:	PHILADELPHIA
State	:	MS
Zip	:	39350-9121
Country	:	US
Telephone Number	:	601-656-2776
Fax Number	:

Provider Business Practice Location Address
First Line	:	1058 HOLLAND AVE
Second Line	:
City	:	PHILADELPHIA
State	:	MS
Zip	:	39350-9121
Country	:	US
Telephone Number	:	601-656-2776
Fax Number	:

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	10/10/2012

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