Provider Demographics
NPI:1801136932
Name:DEHAILLECOURT, CATHERINE SUZANNE (OTR)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:SUZANNE
Last Name:DEHAILLECOURT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50811 OLD HIGHWAY 25 S
Mailing Address - Street 2:
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-8642
Mailing Address - Country:US
Mailing Address - Phone:662-257-0507
Mailing Address - Fax:
Practice Address - Street 1:90A CLARK BLVD.
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-2801
Practice Address - Country:US
Practice Address - Phone:662-840-0535
Practice Address - Fax:662-842-7915
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT0207225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist