Provider Demographics
NPI:1013108430
Name:FIFE, SUMMER HAYES (MOTR/L)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:HAYES
Last Name:FIFE
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 OLD COLONY RD
Mailing Address - Street 2:
Mailing Address - City:PORT GIBSON
Mailing Address - State:MS
Mailing Address - Zip Code:39150-2545
Mailing Address - Country:US
Mailing Address - Phone:601-529-9084
Mailing Address - Fax:
Practice Address - Street 1:1069 OLD COLONY RD
Practice Address - Street 2:
Practice Address - City:PORT GIBSON
Practice Address - State:MS
Practice Address - Zip Code:39150-2545
Practice Address - Country:US
Practice Address - Phone:601-529-9084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT2120225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist