Provider Demographics
NPI:1497084545
Name:HARGRAVE, ROSALIND
Entity Type:Individual
Prefix:
First Name:ROSALIND
Middle Name:
Last Name:HARGRAVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-3551
Mailing Address - Country:US
Mailing Address - Phone:601-443-2344
Mailing Address - Fax:601-443-9862
Practice Address - Street 1:344 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-3551
Practice Address - Country:US
Practice Address - Phone:601-443-2344
Practice Address - Fax:601-443-9862
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT1775225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist