Provider Demographics
NPI:1851818652
Name:MARVIN, JOY TILEY (MSOTR/L)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:TILEY
Last Name:MARVIN
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 HIGHWAY 389
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-8451
Mailing Address - Country:US
Mailing Address - Phone:662-769-4888
Mailing Address - Fax:662-338-5439
Practice Address - Street 1:3850 HIGHWAY 45 N
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-1517
Practice Address - Country:US
Practice Address - Phone:662-769-4888
Practice Address - Fax:662-338-5439
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT2915225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty