Provider Demographics
NPI:1639394588
Name:LOWE, JONELLA HOMER (OTR-L)
Entity Type:Individual
Prefix:MRS
First Name:JONELLA
Middle Name:HOMER
Last Name:LOWE
Suffix:
Gender:F
Credentials:OTR-L
Other - Prefix:
Other - First Name:JONELLA
Other - Middle Name:GWENAY
Other - Last Name:HOMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:83 RUGER RD
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465-5800
Mailing Address - Country:US
Mailing Address - Phone:601-582-5832
Mailing Address - Fax:
Practice Address - Street 1:711 AVIGNON DR
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5120
Practice Address - Country:US
Practice Address - Phone:601-605-6777
Practice Address - Fax:601-605-8869
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT0211225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist