Provider Demographics
NPI:1750885588
Name:OPTIMUM OCCUPATIONAL THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:OPTIMUM OCCUPATIONAL THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER-MANAGER, CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OTR/L, SCLV
Authorized Official - Phone:662-455-0030
Mailing Address - Street 1:PO BOX 573
Mailing Address - Street 2:
Mailing Address - City:BELZONI
Mailing Address - State:MS
Mailing Address - Zip Code:39038-0573
Mailing Address - Country:US
Mailing Address - Phone:662-455-0030
Mailing Address - Fax:662-247-1489
Practice Address - Street 1:706 HIGHWAY 82 W
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-5028
Practice Address - Country:US
Practice Address - Phone:662-455-0030
Practice Address - Fax:662-247-1489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-18
Last Update Date:2022-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow VisionGroup - Single Specialty