Provider Demographics
NPI:1215591169
Name:MCGUIRE, FERRIS O'BANNON (OTR/L)
Entity Type:Individual
Prefix:
First Name:FERRIS
Middle Name:O'BANNON
Last Name:MCGUIRE
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 LAKEWOOD DR STE 2
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-3017
Mailing Address - Country:US
Mailing Address - Phone:662-563-2579
Mailing Address - Fax:
Practice Address - Street 1:171 LAKEWOOD DR STE 2
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-3017
Practice Address - Country:US
Practice Address - Phone:662-563-2579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT3533225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation