Provider Demographics
NPI:1558696658
Name:OT 4 KIDZ, LLC LLC APPLIED FOR
Entity Type:Organization
Organization Name:OT 4 KIDZ, LLC LLC APPLIED FOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:662-312-8388
Mailing Address - Street 1:1754 HICKORY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-9720
Mailing Address - Country:US
Mailing Address - Phone:662-312-8388
Mailing Address - Fax:662-338-5439
Practice Address - Street 1:501 HIGHWAY 12 W
Practice Address - Street 2:SUITE 150 A&C
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-3654
Practice Address - Country:US
Practice Address - Phone:662-338-5439
Practice Address - Fax:662-338-5439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT0179225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty