Provider Demographics
NPI:1417719980
Name:PRENTISS, CECELIA CLAIRE (OT)
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:CLAIRE
Last Name:PRENTISS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 BIENVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5975
Mailing Address - Country:US
Mailing Address - Phone:228-300-2857
Mailing Address - Fax:
Practice Address - Street 1:4214 BIENVILLE BLVD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5975
Practice Address - Country:US
Practice Address - Phone:228-300-2857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics