Provider Demographics
NPI:1932512951
Name:HESSION, MANDALYNN NICHOLE
Entity Type:Individual
Prefix:MRS
First Name:MANDALYNN
Middle Name:NICHOLE
Last Name:HESSION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1559 CAMP EIGHT RD
Mailing Address - Street 2:
Mailing Address - City:RICHTON
Mailing Address - State:MS
Mailing Address - Zip Code:39476-8922
Mailing Address - Country:US
Mailing Address - Phone:601-408-4285
Mailing Address - Fax:
Practice Address - Street 1:206 BAY AVE
Practice Address - Street 2:
Practice Address - City:RICHTON
Practice Address - State:MS
Practice Address - Zip Code:39476-2941
Practice Address - Country:US
Practice Address - Phone:601-788-6316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT2923225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist