Provider Demographics
NPI:1669692620
Name:THERAPEUTIC EXPREXXIONS REHAB, INC.
Entity type:Organization
Organization Name:THERAPEUTIC EXPREXXIONS REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NOLA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:RAYSON-LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:662-621-1701
Mailing Address - Street 1:122 DESOTO AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-4420
Mailing Address - Country:US
Mailing Address - Phone:662-621-1701
Mailing Address - Fax:662-621-1702
Practice Address - Street 1:122 DESOTO AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-4420
Practice Address - Country:US
Practice Address - Phone:662-621-1701
Practice Address - Fax:662-621-1702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSOT0686OtherOCCUPATIONAL THERAPIST