MEDICARE: KELLY HARRINGTON 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
1	225X00000X	Occupational Therapist	OT-0370	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OT-0370	OTHER	MS	OT LICENSE NUMBER

General Provider Information

NPI Number	:	1982312484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY HARRINGTON OT

Provider Business Mailing Address
First Line	:	921 W BEACON ST
Second Line	:
City	:	PHILADELPHIA
State	:	MS
Zip	:	39350-3229
Country	:	US
Telephone Number	:	601-650-0002
Fax Number	:

Provider Business Practice Location Address
First Line	:	1976 HIGHWAY 43 N STE F
Second Line	:
City	:	CANTON
State	:	MS
Zip	:	39046-4962
Country	:	US
Telephone Number	:	601-667-3144
Fax Number	:

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

Provider Enumeration Date	:	11/14/2022
Last Update Date	:	11/14/2022

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Directions to “ KELLY HARRINGTON OT” Practice Location

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