Provider Demographics
NPI:1255952453
Name:INNOVATIVE HANDS OF THERAPY SERVICES LLC
Entity type:Organization
Organization Name:INNOVATIVE HANDS OF THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NIESHA
Authorized Official - Middle Name:LASHA
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:601-951-7458
Mailing Address - Street 1:519 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39203-1825
Mailing Address - Country:US
Mailing Address - Phone:601-951-7458
Mailing Address - Fax:
Practice Address - Street 1:519 SCOTT ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39203-1825
Practice Address - Country:US
Practice Address - Phone:601-951-7458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty