Provider Demographics
NPI:1710122122
Name:NAIDOO, VANESSA (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:
Last Name:NAIDOO
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7075 GOLDEN OAKS LOOP W STE 6
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-9011
Mailing Address - Country:US
Mailing Address - Phone:901-335-8468
Mailing Address - Fax:662-349-3988
Practice Address - Street 1:7075 GOLDEN OAKS LOOP W STE 6
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671
Practice Address - Country:US
Practice Address - Phone:901-335-8468
Practice Address - Fax:662-349-3988
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-14
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT0000001837225X00000X
MSOT2230225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist