Provider Demographics
NPI:1578013678
Name:MIKELS, EMMA (OT)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:MIKELS
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 1:1263 ROAD 931
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-8260
Mailing Address - Country:US
Mailing Address - Phone:205-412-6970
Mailing Address - Fax:
Practice Address - Street 1:1263 ROAD 931
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-8260
Practice Address - Country:US
Practice Address - Phone:205-412-6970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0756225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist