Provider Demographics
NPI:1467956508
Name:KNOX, JIMMY ERIC (OTRIL, CDRS)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:ERIC
Last Name:KNOX
Suffix:
Gender:M
Credentials:OTRIL, CDRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 9736
Mailing Address - Street 2:
Mailing Address - City:MISSISSIPPI STATE
Mailing Address - State:MS
Mailing Address - Zip Code:39762
Mailing Address - Country:US
Mailing Address - Phone:662-325-1028
Mailing Address - Fax:662-325-0896
Practice Address - Street 1:326 HORDY RD
Practice Address - Street 2:
Practice Address - City:MISSISSIPPI STATE
Practice Address - State:MI
Practice Address - Zip Code:39762
Practice Address - Country:US
Practice Address - Phone:662-325-1028
Practice Address - Fax:662-325-0896
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT2774225XE0001X, 225XP0200X, 225XR0403X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community Mobility