Provider Demographics
NPI:1306011861
Name:MCEWEN, JEFFREY HAROLD (OTRL)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:HAROLD
Last Name:MCEWEN
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 LIN FRANK DRIVE
Mailing Address - Street 2:
Mailing Address - City:SMITHDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39664
Mailing Address - Country:US
Mailing Address - Phone:601-567-9632
Mailing Address - Fax:
Practice Address - Street 1:3420 LIN FRANK DRIVE
Practice Address - Street 2:
Practice Address - City:SMITHDALE
Practice Address - State:MS
Practice Address - Zip Code:39664
Practice Address - Country:US
Practice Address - Phone:601-567-9632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT2040225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist