Provider Demographics
NPI:1669100202
Name:JONES, KAELA MARIE (OTD, OTR/L)
Entity type:Individual
Prefix:MISS
First Name:KAELA
Middle Name:MARIE
Last Name:JONES
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 RIDGE PARK DR
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:MS
Mailing Address - Zip Code:39154-7511
Mailing Address - Country:US
Mailing Address - Phone:601-473-6915
Mailing Address - Fax:
Practice Address - Street 1:806 W GEORGETOWN ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39059-9453
Practice Address - Country:US
Practice Address - Phone:601-473-6915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT3959225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSOT3959OtherN/A