Provider Demographics
NPI:1225926272
Name:AUTUMN TAMOR
Entity type:Organization
Organization Name:AUTUMN TAMOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUTUMN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMOR
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:601-345-1784
Mailing Address - Street 1:1229 POPLAR BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2110
Mailing Address - Country:US
Mailing Address - Phone:601-345-1784
Mailing Address - Fax:
Practice Address - Street 1:116 MARKETRIDGE DR
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-6009
Practice Address - Country:US
Practice Address - Phone:601-345-1784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty