Provider Demographics
NPI:1740633312
Name:NORTH MISSISSIPPI HAND THERAPY
Entity type:Organization
Organization Name:NORTH MISSISSIPPI HAND THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MACON
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CHT
Authorized Official - Phone:662-281-0022
Mailing Address - Street 1:2714 W OXFORD LOOP
Mailing Address - Street 2:SUITE 164
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5711
Mailing Address - Country:US
Mailing Address - Phone:662-281-0022
Mailing Address - Fax:662-281-0067
Practice Address - Street 1:187 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-2542
Practice Address - Country:US
Practice Address - Phone:662-578-2110
Practice Address - Fax:662-578-2108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT1383225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty