Provider Demographics
NPI:1962628925
Name:ABILITY ONE REHABILITATION
Entity Type:Organization
Organization Name:ABILITY ONE REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTRL
Authorized Official - Phone:662-292-0329
Mailing Address - Street 1:298 PEACH ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:SENATOBIA
Mailing Address - State:MS
Mailing Address - Zip Code:38668-3841
Mailing Address - Country:US
Mailing Address - Phone:662-292-0329
Mailing Address - Fax:
Practice Address - Street 1:298 PEACH ORCHARD RD
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-3841
Practice Address - Country:US
Practice Address - Phone:662-292-0329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT1782225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06920587Medicaid
MSC03270Medicare ID - Type UnspecifiedMS MEDICARE PART B